Ductal Carcinoma In Situ: A Rose by Any Other Name
Cet éditorial et ce commentaire passent en revue les controverses concernant la prise en charge thérapeutique du carcinome canalaire in situ du sein
Until the late 1970s or early 1980s, the treatment of what was then called noninvasive intraductal carcinoma was relatively straightforward. Patients were told they had a very good prognosis, and they were treated with a mastectomy. At some centers, they received a radical mastectomy, “just to be cautious.” What is now called ductal carcinoma in situ (DCIS) was an uncommon breast cancer, representing less than 5% of new cases, and most of these were palpable lesions.
Today, largely as a result of data from clinical trials, patients with newly diagnosed DCIS have the option of breast-conserving surgery, and the majority select that option (1,2). What was once an uncommon finding now represents up to 25% of new breast cancers and as much as 33% of mammographically detected breast cancers (3). Assuming there is no increase in the prevalence of DCIS, the increased incidence is likely due to the use of screening mammograms and of breast magnetic resonance imaging, which provides improved technological ability to detect the disease, along with core needle biopsy, which has made the ability to sample image-detected lesions more feasible and rapid.
With this increase in incidence, new dilemmas in the postsurgical treatment of DCIS have arisen. In this issue of the Journal, Punglia, Schmitt, and Weeks (4) outline the current difficulties associated with the management of DCIS and suggest…
Journal of the National Cancer Institute , éditorial, 2013