Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK; Anglia Ruskin University, Cambridge, UK.
Lancet Oncol. 2013 Aug;14(9):e348-57. doi: 10.1016/S1470-2045(13)70135-9.
Ductal carcinoma in situ (DCIS) constitutes a major public health problem, with up to half of screen-detected cancers representing pure forms of DCIS without evidence of invasion. A proportion of cases detected with routine screening would not have progressed to a life-threatening form of breast cancer during the patient's lifetime, and overdiagnosis of breast cancer is a cause for concern. Once DCIS has been detected, treatment is obligatory and present technologies do not allow accurate risk stratification such that intensity of treatment can be tailored to risk of recurrence and progression to invasive disease. Present management strategies are based on prognostic and predictive information derived from conventional histopathological and host factors. With increasing molecular characterisation of these preinvasive lesions, data will be available for how factors such as oestrogen receptor, progesterone receptor, HER2, and indicators of proliferative activity can provide additional information about both prognosis and benefit from adjuvant treatments such as radiotherapy and hormonal therapy. Low-risk patients are especially poorly defined in terms of need for adjuvant therapies, which can be associated with both short-term adverse sequelae and long-term effects (eg, cardiotoxicity) that can affect all-cause mortality. Optimum risk prediction in the future is likely to be achieved by integration of both conventional and molecular factors, which should be incorporated into a validated predictive model to help with clinical decision making.
导管原位癌（DCIS）是一个主要的公共卫生问题，多达一半的筛查癌症代表了没有浸润证据的纯 DCIS 形式。在患者的一生中，一部分通过常规筛查发现的病例不会发展为危及生命的乳腺癌形式，并且乳腺癌的过度诊断令人担忧。一旦发现 DCIS，就必须进行治疗，而目前的技术无法进行准确的风险分层，因此无法根据复发和进展为浸润性疾病的风险来调整治疗强度。目前的管理策略基于从常规组织病理学和宿主因素中得出的预后和预测信息。随着这些癌前病变的分子特征不断增加，将有数据可用于了解雌激素受体、孕激素受体、HER2 以及增殖活性指标等因素如何提供有关预后和辅助治疗（如放疗和激素治疗）获益的额外信息。低风险患者在需要辅助治疗方面尤其难以确定，辅助治疗可能会带来短期不良后果和长期影响（例如，心脏毒性），从而影响全因死亡率。未来，通过整合常规和分子因素，有望实现最佳风险预测，这些因素应纳入经过验证的预测模型，以帮助进行临床决策。
