MANAGEMENT OF DUCTAL CARCINOMA IN-SITU

Ductal carcinoma in situ (DCIS) is an early, localized stage of breast carcinoma that has an excellent prognosis when it is properly treated . The significant increase in the frequency of diagnosis of DCIS in re cent years is the result of both better recognition of DCIS among path ologists and widespread use of screening mammography. Multicentricity, bilaterality and histologic subtype are important considerations in t he management of this disease. The clinical presentation of DCIS is th e presence of either a palpable mass or a mammographic abnormality, mo st frequently in the form of an area of microcalcifications. For sever al decades, total mastectomy was considered the appropriate treatment for DCIS, and it should still be considered the standard to which more conservative forms of treatment must be compared. Breast conservation surgery has been used with increasing frequency in the treatment of D CIS but the adequacy of this approach remains subject to controversy. Segmental mastectomy alone may be applied with caution in carefully se lected patients, while the rest of the patients undergoing breast cons ervation surgery should be treated with breast irradiation. Axillary n ode dissection is generally considered unnecessary in the treatment of DCIS. There is no role for adjuvant chemotherapy in the management of this disease. The role of tamoxifen in the treatment of DCIS is not c learly defined and it should be given only to patients enrolled in cli nical trials. Ongoing research should clarify the controversies surrou nding DCIS and enable us to define the optimal management for this dis ease.