%0 Journal Article
%T Ductal Carcinoma In Situ of the Breast: A Surgical Perspective
%A Mohammed Badruddoja
%J International Journal of Surgical Oncology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/761364
%X Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous neoplasm with invasive potential. Risk factors include age, family history, hormone replacement therapy, genetic mutation, and patient lifestyle. The incidence of DCIS has increased due to more widespread use of screening and diagnostic mammography; almost 80% of cases are diagnosed with imaging with final diagnosis established by biopsy and histological examination. There are various classification systems used for DCIS, the most recent of which is based on the presence of intraepithelial neoplasia of the ductal epithelium (DIN). A number of molecular assays are now available that can identify high-risk patients as well as help establish the prognosis of patients with diagnosed DCIS. Current surgical treatment options include total mastectomy, simple lumpectomy in very low-risk patients, and lumpectomy with radiation. Adjuvant therapy is tailored based on the molecular profile of the neoplasm and can include aromatase inhibitors, anti-estrogen, anti-progesterone (or a combination of antiestrogen and antiprogesterone), and HER2 neu suppression therapy. Chemopreventive therapies are under investigation for DCIS, as are various molecular-targeted drugs. It is anticipated that new biologic agents, when combined with hormonal agents such as SERMs and aromatase inhibitors, may one day prevent all forms of breast cancer. 1. Introduction Ductal carcinoma in situ (DCIS) of the breast is a noninvasive carcinoma with a wide spectrum of disease, ranging from low-grade to high-grade malignancy with foci of invasive malignancy. Histologically, DCIS is characterized by a proliferation of malignant cells in the ductal epithelium that are confined to the basement membrane and are not invading the normal breast parenchyma. 2. Epidemiology Prior to advent of mammography, the diagnosis of DCIS was established only after excision of palpable lumps and histological examination of the tissue. Egan et al. [1], a radiologist based at the MD Anderson Cancer Center in Houston, Texas, is credited as the inventor of mammography in the late 1960s. By 1975, the widespread use of this imaging technique not only resulted in early detection of lesions in the breast but also led to a 60¨C70% reduction in morbidity and mortality from malignant diseases of breast [2]. The adoption of screening and diagnostic mammography resulted in an increase in the incidence of DCIS worldwide, with 80% of DCIS diagnosed by mammography. Currently, DCIS accounts for 20¨C25% of all newly diagnosed cases of breast cancer [3] and 17¨C34% of
%U http://www.hindawi.com/journals/ijso/2012/761364/