Management of Ductal Carcinoma in Situ of the Breast

Guideline

The objective of this guideline was to determine the most effective therapy options for patients with ductal carcinoma in situ (DCIS) of the breast.

Patient Population

These recommendations apply to women with DCIS, including women with DCIS with microinvasion (DCIS-M) (< 1 mm through the duct).

Intended Guideline Users

Intended users of this guideline are clinicians and other healthcare professionals involved in the management of patients with DCIS.

Research Question(s)

1. What is the optimal surgical treatment for patients with DCIS when considering DFS, recurrence, and significant complications after surgery (i.e. bleeding or infection)?
2. a) What margin width minimizes the risk of recurrence, complications after surgery (i.e. bleeding, infection) and increases disease free survival in patients with DCIS receiving BCS?
   b) After initial surgery of BCS or MX with suboptimal margin width (close or positive), should re-excision be considered to improve DFS, recurrence or reduce complications after surgery requiring reoperation within 30 days (i.e. bleeding or infection)?
3. Should molecular profile testing be added to clinical evaluation to guide the use of any adjuvant therapy in patients with DCIS?
4. In DCIS patients who have undergone BCS or MX, should breast irradiation be offered to improve DFS and reduce recurrence with acceptable adverse events of irradiation?
5. In DCIS patients who have undergone BCS or MX, what is the role of endocrine therapy in the management of DCIS to improve DFS and reduce recurrence and contralateral events with acceptable treatment adverse events?