Noninvasive Carcinoma

As with invasive carcinoma, the noninvasive lesions may be divided broadly into ductal and lobular categories. The widespread use of screening mammography and subsequent biopsy, coupled with recognition of noninvasive breast carcinoma by pathologists, has resulted in a significant increase in the diagnosis of in situ breast cancer during the past decade. A detailed discussion of the biology and appropriate management of noninvasive breast cancer is beyond the scope of this chapter, but some of the more salient characteristics of ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) are described below, and the reader is referred to a number of excellent reviews for a more comprehensive discussion.13,14

DCIS is seen more frequently than LCIS. It is important to note that carcinoma in situ is treated as cancer. Simple or total mastectomy (without lymph node dissection) has been the standard treatment of DCIS for several decades. Breast conservation, i.e., wide local excision followed by irradiation of breast tissue, may be an effective alternative to mastectomy. Although radiation following lumpectomy does not appear to change the survival of patients with DCIS, it significantly reduces the incidence of local recurrences and enhances the breast preservation rate in these women. Axillary dissection generally is not indicated because there is only a 1% incidence of axillary node involvement. There is currently no proven benefit for the use of cyto-toxic chemotherapy in patients who receive local therapy for DCIS. However, there are subgroups of patients with DCIS, such as hormone receptor-positive patients, who may benefit from the addition of tamoxifen to lumpectomy plus radiation.15

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