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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.


M. Toss

I. Miligy

A.M. Thompson

H. Khout

Professor of Breast Cancer Pathology


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.


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
Keywords Breast; Duct carcinoma in situ; DCIS; Management
Public URL
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