MANAGEMENT OF DUCTAL CARCINOMA IN-SITU OF THE BREAST

The advent of mammographic breast screening has increased the detectio n of ductal carcinoma in situ (DCIS), which now accounts for 15-20% of all breast cancer. While symptomatic DCIS has been treated satisfacto rily by mastectomy, this may be an overtreatment of smaller screen-det ected lesions. Although local excision, with or without radiotherapy, is associated with a significant risk of local recurrence of DCIS or i nvasive cancer, salvage surgery is usually successful. The long-term b reast-specific mortality rate of treatment by mastectomy and local exc ision are similar. Whereas mastectomy is still appropriate for women w ith lesions > 30 mm in diameter or centrally placed and for those wome n who demand the best possible disease-free survival, local surgery sh ould otherwise be considered.