Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology

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Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

  • 1.

    College of American Pathologists. Protocols and guidelines. Available at: http://www.cap.org. Accessed February 26, 2018.

  • 2.

    Kerlikowske K, Molinaro AM, Gauthier ML. Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J Natl Cancer Inst 2010;102:627637.

    • Search Google Scholar
    • Export Citation
  • 3.

    Stackievicz R, Paran H, Bernheim J. Prognostic significance of HER-2/neu expression in patients with ductal carcinoma in situ. Isr Med Assoc J 2010;12:290295.

    • Search Google Scholar
    • Export Citation
  • 4.

    Zhou W, Jirstrom K, Johansson C. Long-term survival of women with basal-like ductal carcinoma in situ of the breast: a population-based cohort study. BMC Cancer 2010;10:653.

    • Search Google Scholar
    • Export Citation
  • 5.

    Lari SA, Kuerer HM. Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer 2011;2:232261.

  • 6.

    Kuhl CK, Schrading S, Bieling HB. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 2007;370:485492.

    • Search Google Scholar
    • Export Citation
  • 7.

    Allen LR, Lago-Toro CE, Hughes JH. Is there a role for MRI in the preoperative assessment of patients with DCIS? Ann Surg Oncol 2010;17:23952400.

    • Search Google Scholar
    • Export Citation
  • 8.

    Davis KL, Barth RJ Jr., Gui J. Use of MRI in preoperative planning for women with newly diagnosed DCIS: risk or benefit? Ann Surg Oncol 2012;19:32703274.

    • Search Google Scholar
    • Export Citation
  • 9.

    Pilewskie M, Olcese C, Eaton A. Perioperative breast MRI is not associated with lower locoregional recurrence rates in DCIS patients treated with or without radiation. Ann Surg Oncol 2014;21:15521560.

    • Search Google Scholar
    • Export Citation
  • 10.

    Waddell BE, Stomper PC, DeFazio JL. Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast. Ann Surg Oncol 2000;7:665668.

    • Search Google Scholar
    • Export Citation
  • 11.

    Cody HS, Van Zee KJ. Point: sentinel lymph node biopsy is indicated for patients with DCIS. J Natl Compr Canc Netw 2003;1:199206.

  • 12.

    Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010;102:170178.

    • Search Google Scholar
    • Export Citation
  • 13.

    Edge SB, Sheldon DG. Counterpoint: sentinel lymph node biopsy is not indicated for ductal carcinoma in situ. J Natl Compr Canc Netw 2003;1:207212.

    • Search Google Scholar
    • Export Citation
  • 14.

    Lyman GH, Giuliano AE, Somerfield MR. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23:77037720.

    • Search Google Scholar
    • Export Citation
  • 15.

    Brennan ME, Turner RM, Ciatto S. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 2011;260:119128.

    • Search Google Scholar
    • Export Citation
  • 16.

    Bijker N, Meijnen P, Peterse JL. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 2006;24:33813387.

    • Search Google Scholar
    • Export Citation
  • 17.

    Emdin SO, Granstrand B, Ringberg A. SweDCIS: radiotherapy after sector resection for ductal carcinoma in situ of the breast. Results of a randomised trial in a population offered mammography screening. Acta Oncol 2006;45:536543.

    • Search Google Scholar
    • Export Citation
  • 18.

    Fisher B, Dignam J, Wolmark N. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441452.

    • Search Google Scholar
    • Export Citation
  • 19.

    Houghton J, George WD, Cuzick J. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet 2003;362:95102.

    • Search Google Scholar
    • Export Citation
  • 20.

    Julien JP, Bijker N, Fentiman IS. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000;355:528533.

    • Search Google Scholar
    • Export Citation
  • 21.

    Cuzick J, Sestak I, Pinder SE. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 2011;12:2129.

    • Search Google Scholar
    • Export Citation
  • 22.

    Wapnir IL, Dignam JJ, Fisher B. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011;103:478488.

    • Search Google Scholar
    • Export Citation
  • 23.

    McCormick B, Winter K, Hudis C. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol 2015;33:709715.

    • Search Google Scholar
    • Export Citation
  • 24.

    Holmberg L, Garmo H, Granstrand B. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol 2008;26:12471252.

    • Search Google Scholar
    • Export Citation
  • 25.

    Goodwin A, Parker S, Ghersi D, Wilcken N. Post-operative radiotherapy for ductal carcinoma in situ of the breast--a systematic review of the randomised trials. Breast 2009;18:143149.

    • Search Google Scholar
    • Export Citation
  • 26.

    Narod SA, Iqbal J, Giannakeas V. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol 2015;1:888896.

  • 27.

    Sagara Y, Freedman RA, Vaz-Luis I. Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ: a population-based longitudinal cohort study. J Clin Oncol 2016;34:11901196.

    • Search Google Scholar
    • Export Citation
  • 28.

    Bartelink H, Horiot JC, Poortmans PM. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007;25:32593265.

    • Search Google Scholar
    • Export Citation
  • 29.

    Bartelink H, Maingon P, Poortmans P. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 2015;16:4756.

    • Search Google Scholar
    • Export Citation
  • 30.

    Romestaing P, Lehingue Y, Carrie C. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol 1997;15:963968.

    • Search Google Scholar
    • Export Citation
  • 31.

    Polgar C, Fodor J, Orosz Z. Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer first results of the randomized Budapest boost trial. Strahlenther Onkol 2002;178:615623.

    • Search Google Scholar
    • Export Citation
  • 32.

    Moran MS, Zhao Y, Ma S. Association of radiotherapy boost for ductal carcinoma in situ with local control after whole-breast radiotherapy. JAMA Oncol 2017;3:10601068.

    • Search Google Scholar
    • Export Citation
  • 33.

    Di Saverio S, Catena F, Santini D. 259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat 2008;109:405416.

    • Search Google Scholar
    • Export Citation
  • 34.

    Gilleard O, Goodman A, Cooper M. The significance of the Van Nuys prognostic index in the management of ductal carcinoma in situ. World J Surg Oncol 2008;6:6161.

    • Search Google Scholar
    • Export Citation
  • 35.

    Silverstein MJ, Lagios MD, Craig PH. A prognostic index for ductal carcinoma in situ of the breast. Cancer 1996;77:22672274.

  • 36.

    Silverstein MJ, Lagios MD, Groshen S. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:14551461.

    • Search Google Scholar
    • Export Citation
  • 37.

    Hughes LL, Wang M, Page DL. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2009;27:53195324.

    • Search Google Scholar
    • Export Citation
  • 38.

    MacDonald HR, Silverstein MJ, Mabry H. Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins. Am J Surg 2005;190:521525.

    • Search Google Scholar
    • Export Citation
  • 39.

    Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol 2009;27:16151620.

    • Search Google Scholar
    • Export Citation
  • 40.

    Van Zee KJ, Subhedar P, Olcese C. Relationship between margin width and recurrence of ductal carcinoma in situ: analysis of 2996 women treated with breast-conserving surgery for 30 years. Ann Surg 2015;262:623631.

    • Search Google Scholar
    • Export Citation
  • 41.

    Morrow M, Van Zee KJ, Solin LJ. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma In situ. J Clin Oncol 2016;34:40404046.

    • Search Google Scholar
    • Export Citation
  • 42.

    Fisher B, Costantino JP, Wickerham DL. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005;97:16521662.

    • Search Google Scholar
    • Export Citation
  • 43.

    Fisher B, Costantino JP, Wickerham DL. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:13711388.

    • Search Google Scholar
    • Export Citation
  • 44.

    Tan-Chiu E, Wang J, Costantino JP. Effects of tamoxifen on benign breast disease in women at high risk for breast cancer. J Natl Cancer Inst 2003;95:302307.

    • Search Google Scholar
    • Export Citation
  • 45.

    Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:16871717.

    • Search Google Scholar
    • Export Citation
  • 46.

    Allred DC, Bryant J, Land S. Estrogen receptor expression as a predictive marker of the effectiveness of tamoxifen in the treatment of DCIS: findings from the NSABP Protocol B-24 [abstract]. Breast Cancer Res Treat 2002;76(Suppl 1):Abstract A30.

    • Search Google Scholar
    • Export Citation
  • 47.

    Forbes JF, Sestak I, Howell A. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet 2016;886873.

    • Search Google Scholar
    • Export Citation
  • 48.

    Margolese RG, Cecchini RS, Julian TB. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016;849856.

    • Search Google Scholar
    • Export Citation
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