Ductal carcinoma in situ

Evidence-based reports and recommendations regarding clinical practice serve as a reference for experienced practitioners and as a resource for clinical trainees. Such recommendations should take into account what is feasible in current practice and recognise that results obtained in controlled clinical trials may not always be realised in routine practice. The recommendations contained in this document address the management of the following conditions: ductal carcinoma in situ (DCIS), atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). They bring together the conclusions of two separate working groups established by the National Breast Cancer Centre* – the DCIS Working Group and the LCIS and AH* Working Group – supported by the National Breast Cancer Centre’s Secretariat. Currently about 1200 women are diagnosed with DCIS each year in Australia.1 DCIS is not an invasive cancer; some would say that it is not a cancer at all. Nevertheless, its close association with invasive breast cancer has serious implications for women who develop DCIS.

There is a need to achieve consensus among health professionals about the nature of this disease and its management. The increasing frequency of diagnosis of DCIS associated with mammographic screening programs underlines the need for reliable information about this condition for clinicians and consumers. Among clinicians, there will be many who are already familiar with the evidence and the principles presented here; for others, the presentation of relevant evidence may provide a clearer understanding of the management of this particularly difficult condition.

LCIS and the atypical hyperplasias – ADH and ALH – are also associated with an increased risk of invasive breast cancer. It therefore seemed appropriate that these conditions should be considered together with DCIS in relation to the management and subsequent risk of invasive breast cancer.The National Breast Cancer Centre’s DCIS, LCIS and AH Working Groups and the Early Detection and Diagnosis Expert Advisory Group have paid particular attention to the emotional and psychological needs of women diagnosed with DCIS, ADH, LCIS or ALH. In particular, the confusion caused by the term ‘carcinoma’ (albeit in situ) in relation to DCIS and LCIS, and the uncertainty of outcome after treatment can contribute to a psychological morbidity which is comparable to that experienced by women with invasive breast cancer.The provision of appropriate support for women diagnosed with DCIS, ADH, LCIS or ALH is therefore an important component of management, and is addressed in this document.

Some of the clinical studies identified in this document are not yet mature, and revising the evidence and recommendations as new data emerge is an important future objective. Health professionals who are involved in the management of the breast conditions addressed here also have a responsibility to consider new information when it becomes available. Relevant research published up to the end of 2000 has been considered for inclusion here and, where appropriate, evidence published up to early 2003 has also been included. It is intended that the document will be updated in 2005, resources permitting.

 

* In February 2008, National Breast Cancer Centre (NBCC) changed its name to National Breast and Ovarian Cancer Centre (NBOCC).

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