english.prescrire.org > Spotlight > Archives : 2013 > Breast cancer: ductal carcinoma in situ - a choice between monitoring and immediate surgery

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Breast cancer: ductal carcinoma in situ - a choice between monitoring and immediate surgery

In cases of asymptomatic ductal carcinoma in situ revealed through mammography screening, clinical monitoring rather than immediate surgery is one of the options to discuss calmly with the patient.

Ductal carcinomas in situ are non invasive cancers with no known risk of symptomatic metastasis. It is hard to predict whether they will develop into an invasive carcinoma, with a less positive prognosis,  since their development is infrequent and slow, sometimes over several decades. Most ductal carcinomas in situ are discovered as a result of mammography screening, and most of them, if left untreated, would never have had any clinical consequences during the patient’s lifetime.

There is no proof that the routine excision of these carcinomas in situ prolongs life or reduces the risk of death from breast cancer. Excision (of the tumour or the breast) makes it possible to confirm the diagnosis, to determine the extent of the carcinoma and to rule out an invasive carcinoma.

For a minority of women affected, excision reduces the risk of an invasive breast cancer developing.

The choice between removing the tumour (lumpectomy) and the total removal of the breast (full mastectomy) is not based on comparative trials. Adding radiotherapy does not modify the mortality rate from breast cancer.

Clinical monitoring rather than immediate surgery is therefore an option to be considered in the case of asymptomatic carcinoma revealed through screening.

Whichever strategy is chosen – simple monitoring, lumpectomy or amputation of the breast – the risks of invasive breast cancer, of  a recurrence or of cancer of the other breast justify thorough and regular breast check-ups.

©Prescrire 1 December 2013

"Treatment of ductal carcinoma in situ. An uncertain harm-benefit balance" Prescrire Int 2013; 22 (144): 298-303 (Pdf, subscribers only).

Download the full review.
Pdf, subscribers only

See also:

"Is too much cancer screening
hazardous to your health?
The example of breast cancer"
(November 2012)

Knowing a disease's
natural history helps
make decisions
(June 2008)

Mammography and
breast cancer screening:
enabling women to make
informed choices
(October 2007)