Informing Patient Decisions Regarding Management of Ductal Carcinoma In Situ

Extract

The Institute of Medicine has identified the management of ductal carcinoma in situ (DCIS) as one of the highest priority topics for comparative effectiveness research. With the rise of mammographic screening, the incidence of DCIS has increased dramatically, and currently about a quarter of all newly diagnosed breast cancers are DCIS. Although DCIS is by definition noninvasive, treatment is necessary because of the risk of development into invasive cancer. Therefore, most patients with DCIS face complex management decisions, including whether to undergo breast-conserving surgery or mastectomy, as well as whether to receive adjuvant radiotherapy and/or tamoxifen.

In this issue of the Journal, Soeteman and colleagues present an intriguing study using simulation modeling to evaluate the trade-offs in lifetime risks and benefits with various approaches for DCIS management ( 1 ). Specifically, they consider mastectomy (with or without reconstruction) and four options for native breast conservation (lumpectomy alone, lumpectomy with radiation, lumpectomy with tamoxifen, and lumpectomy with both radiation and tamoxifen). They compare predicted survival and breast preservation rates at three representative ages: 45, 60, and 70 years.