From the Guidelines
Surgical excision is the mainstay of therapy for Carcinoma In Situ (CIS) of the breast, with options including breast-conserving surgery or mastectomy, often followed by radiation therapy to reduce the risk of recurrence.
Treatment Options
- Breast-conserving surgery: This is a suitable option for most women, and can be followed by whole-breast radiation therapy (WBRT) to reduce the risk of recurrence 1.
- Mastectomy: This may be necessary for women with extensive DCIS or those who cannot undergo radiation therapy, and can be performed with or without sentinel lymph node biopsy (SLNB) and optional reconstruction 1.
- Lumpectomy alone: This may be considered for women with low-risk DCIS, although the risk of recurrence is higher without radiation therapy 1.
Additional Therapies
- Radiation therapy: This can be used after breast-conserving surgery to reduce the risk of recurrence, and may include a radiation boost to the tumor bed to maximize local control 1.
- Adjuvant endocrine therapy: This can be used to reduce the risk of recurrence in women with DCIS, particularly those with estrogen receptor-positive disease, and may include tamoxifen or an aromatase inhibitor (AI) 1.
Considerations
- Patient age: Women over 70 years old with low-risk DCIS may not require radiation therapy after breast-conserving surgery 1.
- Tumor characteristics: The presence of comedonecrosis or close margins may increase the risk of recurrence and necessitate additional therapies such as radiation therapy or adjuvant endocrine therapy 1.
From the Research
Treatment Options for Carcinoma In Situ (CIS) of the Breast
The treatment options for Carcinoma In Situ (CIS) of the breast include:
- Breast-conserving surgery (BCS) alone
- BCS with radiotherapy
- BCS with endocrine therapy
- BCS with radiotherapy and endocrine therapy
- Mastectomy with or without radiotherapy 2, 3, 4, 5
Factors Influencing Treatment Choices
The choice of treatment depends on various factors, including:
- Risk of local recurrence (LR)
- Risk factors for LR, such as young age, inadequate margins, and greater volume of disease
- Patient values and priorities
- Clinicopathologic and treatment factors, such as nuclear grade, presence of necrosis, and receptor status 3, 4, 5
Role of Radiotherapy and Endocrine Therapy
- Radiotherapy reduces the risk of LR by half after BCS 4
- Endocrine therapy reduces the risk of LR by a third after BCS 4
- The role of adjuvant radiotherapy after local excision remains controversial, but may be safely omitted in selected cases with low-risk features 5
Emerging Trends and Future Prospects
- Emerging tools, such as pathologic or biologic markers, may soon change the standard of care for CIS treatment 3
- Innovative treatment strategies, including targeted therapies, immune modulators, and vaccines, are being explored 3, 5
- Active surveillance may be considered for seemingly low-risk patients, but its safety remains uncertain 4