Introduction Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pro- liferation of presumably malignant ep- ithelial cells within the mammary ductal system. Because there is no light-micro- scopic evidence of invasion through the basement membrane into the surround- ing tissue, DCIS is best viewed as a pre- invasive lesion. The increased use of screening mammography over the past two decades has led to a marked increase in the number of patients diagnosed with DCIS, and today, in many centers, one DCIS lesion is diagnosed for every two to three mammographically detected inva- sive breast cancers. Although patients with DCIS have been traditionally treated with mastecto- my, this treatment approach has recently come under scrutiny for several reasons. First, many patients with invasive breast cancer are currently treated with breast- conserving therapy, making it difficult to justify the generalized use of mastectomy for patients with DCIS. In addition, the natural history of DCIS is only partially understood, particularly for small, mam- mographically detected lesions. In this ar- ticle, we will review current concepts re- garding the diagnosis, natural history, and treatment of DCIS. Presentation Prior to the era of mammographic screen- ing, patients with DCIS most often pre- sented with a palpable breast mass or with nipple discharge. Technical improve- ments in mammography and the wide- spread use of screening mammography have led to the increased detection of smaller, clinically occult DCIS lesions. Mammographically, DCIS usually ap- pears as clustered microcalcifications without a soft tissue abnormality, al- though these findings are not specific for DCIS and may be seen with benign le- sions as well as with invasive cancers. In fact, most calcifications are indeterminate mammographically, resulting in biopsy yields of only 20 to 25 percent. The microcalcifications in DCIS are most often secondary to the calcification of necrotic cellular debris within the in- volved ducts, and their extent and charac- teristics are better defined with magnifi- cation views. Suspicious mammographic CA Cancer J Clin 1995;45:244-253 244 Ca—A cancer Journal for Clinicians Management of Ductal Carcinoma In Situ Stella Hetelekidis, MD Stuart J. Schnitt, MD Monica Morrow, MD Jay R. Harris, MD Dr. Hetelekidis is a Radiation Oncologist at the Joint Center for Radiation Therapy and the Brigham and Women’s Hospital and Clinical Instructor at Harvard Medical School in Boston, Massachusetts. Dr. Schnitt is the Associate Director of Surgical Pathology at the Beth Israel Hospital and Associate Professor of Pathology at Harvard Medical School in Boston, Massachusetts. Dr. Morrow is the Director of the Lynn Sage Comprehensive Breast Center and Associate Professor of Surgery in the Department of Surgery of Northwestern University Medical School in Chicago, Illinois. Dr. Harris is the Clinical and Educational Director at the Joint Center for Radiation Therapy and Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts.
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