Behandlung des duktalen Carcinoma in situ

Ductal carcinoma in situ (DCIS) as a non-invasive carcinoma is a precancerous lesion of the breast. The increased use of mammography during the last three decades has led to an approximately tenfold higher incidence of this lesion. The fundamental question underlying treatment and detection of DCIS is whether it should be considered a direct precursor of invasive breast cancer. This reflects our therapeutic dilemma. Current management strategies range from mastectomy to excision plus radiation therapy to excision alone. There is a lack of predictive and prognostic markers and is limited to surrogate markers of clinical behaviour. Expression of oestrogen receptor (ER) is the precondition for endocrine treatment, but nevertheless tamoxifen therapy is not recommended generally. Different studies on the value of HER2 overexpression are ongoing but do not influence our therapy. To date, there has been no subgroup identified where radiation therapy after breast-conserving surgery can be avoided.