Barrio Andrea V, Van Zee Kimberly J
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065; email:
Annu Rev Med. 2017 Jan 14;68:197-211. doi: 10.1146/annurev-med-050715-104920.
Ductal carcinoma in situ (DCIS) accounts for 20% of all newly diagnosed breast cancers. Mastectomy was once the gold standard for the treatment of DCIS; however, breast-conserving surgery (BCS) has been adopted as the treatment of choice for patients with small, screen-detected lesions. Both adjuvant radiation and hormonal therapy following BCS have been demonstrated in randomized trials to reduce the risk of both invasive and DCIS recurrence, but neither affects survival. With the variety of surgical and adjuvant treatment options available, there has been great interest in tailoring the treatment to the individual, with the goal of optimizing the balance of risks and benefits according to the values and priorities of the woman herself. Prospective studies of women with "low-risk" DCIS treated with BCS alone have successfully identified women at lower than average risk but have not achieved the goal of identifying a subset of women with DCIS at minimal risk of recurrence after surgical excision alone. No studies have evaluated the safety of medical management alone.
导管原位癌（DCIS）占所有新诊断乳腺癌的20%。乳房切除术曾是DCIS治疗的金标准；然而，保乳手术（BCS）已被用作筛查出的小病灶患者的首选治疗方法。随机试验表明，BCS术后辅助放疗和激素治疗均可降低浸润性癌和DCIS复发风险，但均不影响生存率。鉴于有多种手术和辅助治疗方案可供选择，人们对根据个体情况量身定制治疗方案兴趣浓厚，目标是根据女性自身的价值观和优先事项优化风险与获益的平衡。对仅接受BCS治疗的“低风险”DCIS女性进行的前瞻性研究成功识别出了风险低于平均水平的女性，但尚未实现识别出手术切除后复发风险极低的DCIS女性亚组这一目标。尚无研究评估单纯药物治疗的安全性。
