Trends in the treatment of ductal carcinoma in situ of the breast
Baxter NN, Virnig BA, Durham SB, Tuttle TM.
Division of Surgical Oncology and School of Public Health, University of Minnesota, Minneapolis 55455, USA.
What Does the Media Report?
There have been significant changes in the the treatment of ductal carcinoma in situ (DCIS) between 1992 and 1999. This study utilized the database from the National Cancer Institute's Surveillance, Epidemiology, and End Results to assess treatment of patients with DCIS with no evidence of microinvasion who were diagnosed from January 1, 1992, through December 31, 1999. This study found a wide variation in the types of treatment patients experienced. These treatment variations ranged from overtreatment to undertreatment. The authors suggested that some of the variation may be a reflection of individual and institutional practice patterns that could be modifiable.
What Does the Doctor's Doctor Say?
Pathologists first defined the concept of DCIS. The concept that most breast cancers may begin in the cells lining the ducts and be limited to the duct was controversial at first. Until this point in time, it was thought that all breast cancers were invasive and could only be cured by radical and potentially disfiguring surgery. Even after the concept of DCIS was introduced, radical surgery was still the treatment of choice. It was only through careful microscopic studies and correlation with the clinical course of these lesions did the truth emerge. DCIS is a form of breast cancer that has an excellent prognosis and is almost always limited to the breast from which it arises. Today, pathologists are at the forefront of defining the histopathological variables that can stratify which types of DCIS are more prone to recurrence or progression to invasive breast cancer. Indeed, the current treatment recommendations could not have been developed without the vital input of pathologists. The Doctor's Doctor has listed some of the classification schemes that are currently used by pathologists to aid surgeons and oncologists with their treatment plans. With further study at the microscopic level, we hope that a standardized treatment plan for DCIS can be adopted so future patients may not have to suffer through the wide variation of treatment plans as the study has uncovered.