Updates on the Management of Ductal Carcinoma In Situ of the Breasts

The current gold standard treatment for ductal carcinoma in situ (DCIS) is by complete excision with a general consensus of 2 mm surgical margin requirement. Adjuvant radiotherapy is usually advised in patients who received lumpectomy. However, over the last decades, de-escalating DCIS treatment has been a debatable topic. Ongoing randomized controlled trials (RCTs) are now in progress to evaluate whether or not we could safely omit surgery in selected low-risk DCIS patients. This chapter aims to summarize the updated evidence on de-escalating DCIS treatment. Retrospective analysis of cancer registry data and systematic review have suggested that selected low-risk DCIS (low-grade and older age patients) can be safely treated conservatively. Ongoing randomized controlled trials (e.g. LORIS trial) are underway to evaluate the long-term clinical outcomes of conservative treatment of selected low-risk DCIS patients. However, apart from oncologic outcomes, the patient’s acceptance and the psychosocial impact of conservative treatment for DCIS should be taken into consideration in the treatment planning for DCIS. The importance of oncologic safety is obvious in decision-making, but to patients, all other aforementioned factors should be equally important. After all, as clinicians, we treat patients, not the DCIS.