Abstrakt
Purpose: According to current knowledge we treat ductal carcinoma in situ (DCIS) as an obligate precursor of invasive breast cancer. The same guidelines are applied to each patient irrespective of the characteristics of the neoplasm.
In future, reliable prognostic factors should help us to assess individual risk better and tailor the therapy accordingly. Material und Methods: A review was done of the relevant literature.
Results: We have been trying to individualize the therapy of DCIS for many years. Obviously we do overtreat some patients by performing surgery with adjuvant radiotherapy.
Our knowledge of reliable prognostic factors for identifying low-risk patients is still inadequate. But while some clinical and histological criteria are accepted, they still do not have any influence on therapy according to the current guidelines.
Dozens of biological markers were evaluated in order to find out whether their expression determines individual risk. As a matter of fact, there are markers indicating an increased risk of recurrence if detected in cancer tissue.
Unfortunately the studies often included only a very small number of patients and the treatment approaches varied. This makes evaluation of the results quite difficult.
No prospective studies were identified at all. Conclusion: In future, we should evaluate a combination of traditional criteria and novel biological markers prospectively in a large number of patients