DCIS Treatment

Goal is to prevent the progression of DCIS to invasive cancer and includes *breast conserving surgery, radiation therapy, and tamoxifen

Surgery: Breast conserving surgery (BCS) involves wide excision of tumor (“lumpectomy”) with negative margins. BCS and mastectomy have equivalent long-term survival rates, but risk of local recurrence slightly higher with BCS. Mastectomy reserved for multicentric or extensive DCIS, otherwise considered overly aggressive. Surgical exploration of axilla is not recommended

Radiation therapy following wide excision reduces risk of local recurrence by 50% compared to excision alone.  Number needed to treat = 9 (to prevent 1 case of local recurrence). Whole breast *radiation begins 1 month or longer after surgery (to allow for healing), and is *given 5 days per week for 5-6 weeks.  Alternate approaches (ex: accelerated partial breast irradiation) under investigation and may be equally effective. *Side effects of RT: 1) radiation pneumonitis (late: pulmonary fibrosis) 2) acute pericarditis (late CAD, cardiomyopathy, conduction problems) 3) lymphedema 4) angiosarcoma (rare)

Tamoxifen (daily x 5 years) is recommended

*High-yield

MALIGNANT BREAST DISORDERS:

DCIS