Does One Size Fit All? 

DCIS is a heterogeneous disease. “Based on the results of several studies it is clear that DCIS represents a broad spectrum of disease and a uniform approach to treatment is not appropriate. Some patients require no treatment other than excision alone, others benefit from complete excision plus radiation therapy, and some will require mastectomy.”  Active surveillance is another important option which should be considered for low grade DCIS.

According to the Lancet Oncology: “ Data derived from histopathological analysis, natural history, radiological characteristics, molecular markers, and clinical outcome indicate that ductal carcinoma in situ (DCIS) is a heterogeneous disease, meaning that no one treatment strategy is best, but rather that treatment should be personalized and entail a systematic and rigorous multidisciplinary approach. Many women with DCIS will develop actual invasive carcinoma over time, whereas others—especially those with low-grade cancers—will not.  At the moment, identification of patients at low risk of recurrence risk is very difficult (that is, such people for whom further treatment beyond lumpectomy is not needed). Understanding one’s particular DCIS pathology is crucial. In depth discussions on the individualized treatment options available can be found in these articles:

• Investigational Paradigms in Downscoring and Upscoring DCIS, International Journal of Surgical Oncology, 2012
• Selecting Individualized Treatment for Patients With Ductal Carcinoma in Situ of the Breast: The Search Continues, 2012 by American Society of Clinical Oncology, Lawrence J. Solin
• http://www.hindawi.com/journals/ijso/2012/560493/
• http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more