Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: critical review

Toss, M.; Miligy, I.; Thompson, A.M.; Khout, H.; Green, A.R.; Ellis, I.O.; Rakha, E.A.

Abstract

The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as “low-risk” using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome.

Citation

Toss, M., Miligy, I., Thompson, A., Khout, H., Green, A., Ellis, I., & Rakha, E. (2017). Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: critical review. Breast, 35, 151-156. doi:10.1016/j.breast.2017.07.012

• Journal Article Type: Article
• Acceptance Date: Jul 13, 2017
• Online Publication Date: Jul 22, 2017
• Publication Date: Oct 30, 2017
• Deposit Date: Oct 18, 2018
• Publicly Available Date: Oct 18, 2018
• Journal: The Breast
• Print ISSN: 0960-9776
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Pages: 151-156
• DOI: https://doi.org/10.1016/j.breast.2017.07.012
• Keywords: Breast; Duct carcinoma in situ; DCIS; Management
• Public URL: https://nottingham-repository.worktribe.com/output/1174048
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S096097761730526X?via%3Dihub