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Review
. 2020 Mar 1;146(5):1189-1197.
doi: 10.1002/ijc.32362. Epub 2019 May 8.

A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

Affiliations
Review

A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

Mieke R Van Bockstal et al. Int J Cancer. .

Abstract

Ductal carcinoma in situ (DCIS) of the breast is a nonobligate precursor of invasive breast cancer, accounting for 20 % of screen-detected breast cancers. Little is known about the natural progression of DCIS because most patients undergo surgery upon diagnosis. Many DCIS patients are likely being overtreated, as it is believed that only around 50 % of DCIS will progress to invasive carcinoma. Robust prognostic markers for progression to invasive carcinoma are lacking. In the past, studies have investigated women who developed a recurrence after breast-conserving surgery (BCS) and compared them with those who did not. However, where there is no recurrence, the patient has probably been adequately treated. The present narrative review advocates a new research strategy, wherein only those patients with a recurrence are studied. Approximately half of the recurrences are invasive cancers, and half are DCIS. So-called "recurrences" are probably most often the result of residual disease. The new approach allows us to ask: why did some residual DCIS evolve to invasive cancers and others not? This novel strategy compares the group of patients that developed in situ recurrence with the group of patients that developed invasive recurrence after BCS. The differences between these groups could then be used to develop a robust risk stratification tool. This tool should estimate the risk of synchronous and metachronous invasive carcinoma when DCIS is diagnosed in a biopsy. Identification of DCIS patients at low risk for developing invasive carcinoma will individualize future therapy and prevent overtreatment.

Keywords: active surveillance; ductal carcinoma in situ; prognostic markers; recurrence; risk stratification.

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Figures

Figure 1
Figure 1
Schematic conceptualization of the novel research strategy. The characteristics of the primary DCIS lesions of patients with in situ and invasive recurrences after breast‐conserving surgery are compared to each other. The majority of patients without recurrences are considered to be adequately treated and are therefore not included in our study. [Color figure can be viewed at http://wileyonlinelibrary.com]

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