Controversies in the treatment of ductal carcinoma in situ.

In summary, certain subgroups of DCIS appear not to require radiation. Corroboration of these results from retrospective reviews and prospective trials is necessary to confirm the safety and efficacy of individualized treatment strategies. Even though the current standard of treatment is (1) lumpectomy with radiation therapy, (2) mastectomy, or (3) mastectomy with reconstruction, it is possible in the future to say that patients with low-grade DCIS (the exact criteria to be defined) may be eligible for breast conservation without radiation, and all patients with high-grade DCIS or perhaps low-grade DCIS with necrosis would be treated best by lumpectomy plus radiation. It is possible that a small subgroup of patients may be best treated by mastectomy, or perhaps, as the results of B-24 become available, by radiation therapy plus tamoxifen. The use of tumor markers such as c-erbB-2, cathepsin D, and NM 23 may help us to better define these subgroups, but much study is necessary before a definite treatment strategy is reached.