TREATMENT OF MAMMARY DUCTAL CARCINOMA IN-SITU

Ductal carcinoma in situ (DCIS) is not a single disease but represents a broad heterogenic group of in situ breast lesions. Today the diagno sis of DCIS is more frequent due to the intensive use of mammography u p to almost 20% of all newly diagnosed breast cancer cases. The routin e use of mastectomy as the only treatment option for DCIS is without d oubt an overtreatment in a substantial number of patients. At a time w here breast conserving therapy for the treatment of patients with smal l invasive breast cancers is currently used, it has become increasingl y difficult to further justify the routine use of mastectomy for DCIS. This seems paradoxical. The close cooperation of surgeons, radiologis ts, pathologists and radiotherapists opens the possibility for more ad equate and better tailored therapy concepts of DCIS. Retrospective and prospective studies allow the development of new pathologic classific ation systems taking into account malignancy grade, size and extension of the DCIS lesion, adequacy of excision and the use of prognostic in dices as more precise predictors for local recurrence. This opens the possibility of different risk-adapted therapeutic options. Hence, brea st conserving therapy is an important option and mastectomy can be omi tted for many DCIS patients.