Is DCIS Breast Cancer, and How Do I Treat it?
Is DCIS Breast Cancer, and How Do I Treat it?
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DOI：
10.1007/s11864-012-0217-1
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发表时间：
2013-03-01
影响因子：
4.3
通讯作者：
Rutgers, E. J. Th.
中科院分区：
文献类型：
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作者：
Bijker, N.;Donker, M.;Rutgers, E. J. Th.
导管原位癌（DCIS）是乳腺癌的一个浸润前阶段，具有异质性的临床行为。自从采用乳房X光检查方案以来，导管原位癌的发病率急剧增加。治疗应侧重于预防进展为侵袭性疾病。如果发生进展，低分化的DCIS通常会导致III级浸润性乳腺癌，而高分化的DCIS更经常作为I级浸润性疾病复发。然而，目前缺乏有效的诊断测试来准确预测进展。大多数DCIS女性适合保乳治疗。获得清晰的手术切缘是局部切除的最重要目标。放射治疗可有效降低局部复发风险，在所有DCIS患者亚组中约为50%。DCIS女性的（乳腺癌特异性）生存率非常好，放疗不能进一步改善这一点。未来的研究应致力于选择具有高侵袭性复发风险的女性，因此放射治疗应成为保乳方法的标准部分，以及那些具有更惰性病变的女性，手术后可以采取观察等待方法。
Ductal carcinoma in situ (DCIS) is a pre-invasive stage of breast cancer with a heterogeneous clinical behaviour. Since the introduction of mammographic screening programmes, the incidence of DCIS has shown a dramatic increase. Treatment should focus on the prevention of progression to invasive disease. If progression occurs, poorly differentiated DCIS frequently gives rise to grade III invasive breast cancer, whereas well differentiated DCIS more often recurs as grade I invasive disease. However, at present, validated diagnostic test are lacking to predict progression accurately. The majority of women with DCIS are suitable for breast conserving therapy. Obtaining clear surgical margins is the most important goal of a local excision. Radiotherapy is effective in reducing the risk of local recurrence with about 50 % in all subgroups of patients with DCIS. (Breast cancer specific) survival of women with DCIS is excellent, and radiotherapy does not further improve this. Future research should be directed in enabling to select women who have a high risk of-invasive-recurrence, so in which radiotherapy should be standard part of the breast conserving approach, and those women with a more indolent lesion, in which after surgery a watchful waiting approach can be followed.