Home

Loading...

Table of contents

Ductal carcinoma in situ

What's new

Updated 2024 ASTRO, 2024 ESMO, and 2020 ASCO/CAP guidelines for the diagnosis and management of ductal carcinoma in situ.

Background

Overview

Definition
DCIS of the breast is the proliferation of malignant epithelial cells within the mammary ductal system without involving the basement membrane or invasion into the surrounding stroma.
1
2
Pathophysiology
DCIS is caused mainly by chromosomal imbalances including loss of heterozygosity and overexpression of the HER2/neu proto-oncogene and mutation in the p53 tumor suppressor gene.
1
2
Disease course
DCIS is clinically silent in most cases; however, a breast lump or bloody nipple discharge may be present. Progression may lead to invasive breast cancer.
1
2
Prognosis and risk of recurrence
DCIS is not associated with any excess risk of death, except in women aged < 50 years with a standard mortality ratio of 3.44 (95% CI 1.85-6.40).
3
4

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of ductal carcinoma in situ are prepared by our editorial team based on guidelines from the American Society for Radiation Oncology (ASTRO 2024,2018), the European Society of Medical Oncology (ESMO 2024), the College of American Pathologists (CAP/ASCO 2020), the U.S. Preventive Services Task Force (USPSTF 2019,2016), the American College of Obstetricians ...
Show more

Screening and diagnosis

Breast cancer screening, average-risk females
As per ESMO 2024 guidelines:
Obtain regular (every 2 years) mammography in average-risk females aged 50-69 years.
A
Consider obtaining regular mammography in females aged 40-49 and 70-74 years, although there is less evidence of benefit.
B
Create free account

More topics in this section

  • Breast cancer screening (high-risk females)

Diagnostic investigations

Hormone receptor testing
As per ASCO/CAP 2020 guidelines:
Obtain estrogen receptor testing in patients with newly diagnosed DCIS (without associated invasion) to assess the potential benefit of endocrine therapies in reducing the risk of future breast cancer.
B
Consider obtaining progesterone receptor testing as an optional measure.
C

Medical management

Adjuvant endocrine therapy
As per ESMO 2024 guidelines:
Consider offering tamoxifen or aromatase inhibitors after local breast-conserving therapy to prevent local recurrence and reduce the risk of developing a second primary breast cancer.
B
Consider offering tamoxifen or aromatase inhibitors after mastectomy to reduce the risk of contralateral breast cancer in patients at high risk of new breast tumors.
C

Therapeutic procedures

Whole-breast irradiation: as per ESMO 2024 guidelines, offer breast-conserving surgery and whole-breast radiotherapy as the preferred treatment in patients with DCIS. Offer mastectomy in cases of extensive or multicentric DCIS.
A

More topics in this section

  • Partial-breast irradiation

Surgical interventions

Breast-conserving surgery: as per ESMO 2024 guidelines, offer breast-conserving surgery and whole-breast radiotherapy as the preferred treatment in patients with DCIS. Offer mastectomy in cases of extensive or multicentric DCIS.
A

Preventative measures

Chemoprophylaxis
As per USPSTF 2019 guidelines:
Offer risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in females at increased risk for breast cancer and at low risk for adverse medication effects.
B
Do not offer risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in females not at increased risk for breast cancer.
D