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Ductal carcinoma in situ (DCIS) is an intraepithelial breast neoplasm accounting for up to 25% of U.S. breast cancers. Treatment for this nonlethal diagnosis remains controversial and ranges widely from no surgery to total mastectomy, often with radiation (RT) and/or endocrine therapy (ET). Recent SEER data show that only 2% of U.S. women receive no surgical treatment, whereas 28% undergo mastectomy, often with sentinel node biopsy.

Although mastectomy rates for DCIS have decreased over the past 40 years, use of RT after wide local excision (WLE) increased by nearly 20% along with a modest increase in ET use. Consequently, DCIS has become a major driver of breast cancer overdiagnosis and overtreatment. A 2009 National Institutes of Health State of Science Conference recommended concerted efforts to decrease indolent DCIS diagnoses, unnecessary surgeries, and excessive adjuvant treatment. Yet, today, despite promising imaging and molecular assays to help optimize DCIS management, these patterns remain largely unchanged or perhaps more prevalent.

In this commentary, we describe ongoing controversies in DCIS diagnosis and management that could influence future clinical trial design.

Read an interview about the commentary here.