The role of excision and surveillance alone in subclinical DCIS of the breast.

Mammography has led to the earlier detection of nonpalpable, subclinical DCIS, either as nonpalpable calcifications or as an incidental finding in a biopsy. Concurrently, the inevitable progression of DCIS to invasive carcinoma has been questioned, so that traditional treatment of this disease has been challenged. Local excision alone for carefully selected patients with DCIS can result in a recurrence rate as low as 15%. Candidates for treatment by surveillance alone after local excision are those patients with a limited area of DCIS on mammography, detected as an area of calcifications 6 cm2 (2.0 to 2.5 cm diameter) or less. Subgroups of DCIS, such as the comedo form, may be more likely to recur. The ultimate objective is to identify the population of patients with subclinical DCIS who are unlikely to suffer recurrence of disease after local excision alone, sparing them from either mastectomy or irradiation.