Management of Ductal Carcinoma In Situ: Opportunities for De-Escalation of Surgery, Radiation, and Treatment

Ductal carcinoma in situ (DCIS) accounts for roughly 25% of all new breast cancer diagnoses. Mortality from DCIS is low and has not significantly changed despite modern, aggressive care. This review will highlight the multiple strategies which are being proposed to de-escalate care, including foregoing sentinel lymph node biopsy (SLNB).

Under 5% of patients undergoing SLNB for DCIS have a positive lymph node, therefore the use of SLNB has been questioned and may be able to be foregone. In addition, recent genomic assays evaluating the benefit of radiation (Oncotype DCIS®, DCISionRT®), have elucidated a group of patients who may not need radiotherapy after breast conservation for DCIS. Finally, the option of foregoing all local treatment and instead focusing on active surveillance is being evaluated in multiple randomized clinical trials including LORIS, LORD and COMET.

Data regarding whether SLNB can be safely omitted and the outcomes of the growing utilization of genomic assays and “watchful waiting” clinical trials remain forthcoming.