Mathelin Carole, Lodi Massimo, Alghamdi Khalid, Arboleda-Osorio Bolivar, Avisar Eli, Anyanwu Stanley, Boubnider Mohcen, Costa Mauricio Maghales, Elder Elisabeth, Elonge Tony, Gebrim Luiz, Hao Xishan, Imoto Shigeru, Meka Esther, Mouelle Michel, Mundinger Alexander, Ostapenko Valerijus, Özbaş Serdar, Özmen Tolga, Özmen Vahit, Pienkowski Tadeusz, Sarria Gustavo, Selim Ashraf, Semiglazov Vladimir, Schneebaum Schlomo
Institut de cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, 67033 Cedex, Strasbourg, France.
Strasbourg University Hospitals, 1 place de l'Hôpital, 67000 Strasbourg, France.
Eur J Breast Health. 2022 Jul 1;18(3):205-221. doi: 10.4274/ejbh.galenos.2022.2022-4-3. eCollection 2022 Jul.
Therapeutic management of ductal carcinoma (DCIS) is heterogeneous among countries worldwide, and some treatment indications are still controversial. To investigate DCIS management in different countries; identify both consensual practices and controversial topics; and survey opinions about the future management of DCIS.
The Senologic International Society network members participated to an online survey using a questionnaire, between November 2021 and February 2022.
Twenty-two responses from 20 different countries showed that organized breast cancer screening programs were present for 87% participants, and DCIS cases represented 13.7% of all breast cancers. Most participants used the grade classification (100%), the morphological classification (78%) and performed immunohistochemistry assays (73%). In case of conservative treatment, the mean re-excision rate was 10.3% and clear margins of mean 2.5 mm were considered healthy. Radical mastectomy rate was 35.5% with a breast reconstruction rate of 53%. Tumor bed boost indications were heterogeneous, and 73% of participants indicated hormone therapy for hormone-positive DCIS. Surgery and radiotherapy omission for some low-risk DCIS were considered by 73% of participants. Multigene assays were used by 43% of participants. Concerning future changes in DCIS management, participants mostly answered surgical de-escalation (48%), radiotherapy de-escalation (35) and/or active surveillance for some cases (22%).
This survey provided an overview of the current practices of DCIS management worldwide. It showed that some areas are rather consensual: incidence increases over time, treatment in young women, pathological classifications, definition of healthy margins, the skin-sparing mastectomy and immediate breast reconstruction. However, some topics are still debated and result in heterogeneous practices, such as evolution in the age of diagnosis, the benefit of de-escalation in low-risk DCIS among elderly women, indications for hormone therapy, radiotherapy omission, or multigene assays. Further evidence is needed to reach consensus on these points, and innovative approaches are still under evaluation in clinical trials. The International Senologic Society, by its members, encourages precision medicine and personalized treatments for DCIS, to avoid overtreatment and overdiagnosis, and provide better healthcare to women with DCIS.
导管原位癌（DCIS）的治疗管理在全球各国存在差异，一些治疗指征仍存在争议。本研究旨在调查不同国家DCIS的管理情况；确定共识性做法和有争议的话题；并调查对DCIS未来管理的意见。
2021年11月至2022年2月期间，国际乳腺病学会网络成员参与了一项在线问卷调查。
来自20个不同国家的22份回复显示，87%的参与者所在地区设有有组织的乳腺癌筛查项目，DCIS病例占所有乳腺癌的13.7%。大多数参与者采用分级分类（100%）、形态学分类（78%）并进行免疫组化检测（73%）。在保乳治疗的情况下，平均再次切除率为10.3%，平均2.5毫米的切缘阴性被视为安全。根治性乳房切除术率为35.5%，乳房重建率为53%。瘤床加量放疗的指征存在差异，73%的参与者表示对激素受体阳性的DCIS进行激素治疗。73%的参与者考虑对一些低风险DCIS不进行手术和放疗。43%的参与者使用多基因检测。关于DCIS管理的未来变化，参与者大多回答为手术降级（48%）、放疗降级（35%）和/或对某些病例进行主动监测（22%）。
本次调查概述了全球DCIS管理的现状。结果表明，在一些方面存在相当的共识：发病率随时间增加、年轻女性的治疗、病理分类、安全切缘的定义、保留皮肤的乳房切除术和即刻乳房重建。然而，一些话题仍存在争议，导致管理方式各异，如诊断年龄的变化、老年女性低风险DCIS降级治疗的益处、激素治疗指征、放疗省略或多基因检测。需要更多证据以就这些问题达成共识，创新方法仍在临床试验中评估。国际乳腺病学会及其成员鼓励对DCIS采用精准医学和个性化治疗，以避免过度治疗和过度诊断，并为DCIS女性提供更好的医疗服务。
