Allegra Carmen J, Aberle Denise R, Ganschow Pamela, Hahn Stephen M, Lee Clara N, Millon-Underwood Sandra, Pike Malcom C, Reed Susan D, Saftlas Audrey F, Scarvalone Susan A, Schwartz Arnold M, Slomski Carol, Yothers Greg, Zon Robin
University of Florida Shands Cancer Center, University of Florida, Gainesville, Florida, USA.
NIH Consens State Sci Statements. 2009 Sep 24;26(2):1-27.
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the diagnosis and management of ductal carcinoma in situ (DCIS).
An non-DHHS, nonadvocate 14-member panel representing the fields of fields of oncology, radiology, surgery (general and reconstructive), pathology, radiation oncology, internal medicine, epidemiology, biostatistics, nursing, obstetrics and gynecology, preventative medicine and population health, and social work. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.
Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.
The diagnosis and management of DCIS is highly complex with many unanswered questions, including the fundamental natural history of untreated disease. Because of the noninvasive nature of DCIS, coupled with its favorable prognosis, strong consideration should be given to remove the anxiety-producing term "carcinoma" from the description of DCIS. The outcomes in women treated with available therapies are excellent. Thus, the primary question for future research must focus on the accurate identification of patient subsets diagnosed with DCIS, including those persons who may be managed with less therapeutic intervention without sacrificing the excellent outcomes presently achieved. Essential in this quest will be the development and validation of accurate risk stratification methods based on a comprehensive understanding of the clinical, radiological, pathological, and biological factors associated with DCIS.
为医疗保健提供者、患者及公众提供关于导管原位癌（DCIS）诊断与管理的现有数据的负责任评估。
一个由14名成员组成的非卫生与公众服务部（DHHS）、非倡导性小组，成员代表肿瘤学、放射学、外科（普通外科和整形重建外科）、病理学、放射肿瘤学、内科、流行病学、生物统计学、护理、妇产科、预防医学与人群健康以及社会工作等领域。此外，来自相关领域的22位专家向小组和会议听众展示了数据。
专家的报告以及明尼苏达循证实践中心通过医疗保健研究与质量局编写的文献系统综述。科学证据优先于轶事经验。
小组根据公开论坛上展示的科学证据和已发表的科学文献起草其声明。声明草案在会议最后一天提交并分发给听众征求意见。小组当天晚些时候在http://consensus.nih.gov上发布了修订后的声明。本声明是小组的独立报告，并非美国国立卫生研究院（NIH）或联邦政府的政策声明。
DCIS的诊断与管理高度复杂，存在许多未解决的问题，包括未经治疗疾病的基本自然史。由于DCIS的非侵袭性及其良好的预后，应强烈考虑从DCIS的描述中去除产生焦虑的术语“癌”。采用现有疗法治疗的女性患者预后良好。因此，未来研究的首要问题必须聚焦于准确识别被诊断为DCIS的患者亚组，包括那些在不牺牲目前所取得的良好预后的情况下可能通过较少治疗干预进行管理的人群。在这一探索过程中，基于对与DCIS相关的临床、放射学、病理学和生物学因素的全面理解，开发和验证准确的风险分层方法至关重要。
