Classification of DCIS; clinical consequences

Treatment of the increasing number of screen detected non-invasive breast cancers is a major problem. The classical ablative, therapy results in nearly 100% cure rate, but may be an overtreatment. The alternative, breast conservation, is being studied in running randomized trials; answers to the most important end points, risk of dying of metastasized. recurrent disease, or of side effects of treatment, requires long follow up. In patients, not eligible for the trials, several tumour characteristics play a role in treatment choice. The extent defines the possibility of breast conservation. The adequacy of excision (min. tumour free margin) may be used to define the need for radiotherapy. As the well differentiated DCIS seem lesions with a low risk of transition into invasive carcinoma, and the subsequent carcinomas are of low grade malignancy, a wait and see policy with close, mammographic and clinical follow up may be applied for these lesions.