Editing DCIS (section)

== Treatment options ==

* Mastectomy
** Indications
*** Patient preference
*** Contraindication to radiotherapy
*** Multicentric or extensive DCIS, or suspected extensive based on mammogram
*** Inability to obtain clear margins with BCS
*** Likelihood of a poor cosmetic result with BCS
*** Unwilling or unable to have follow-up surveillance
*** Recurrence of DCIS after prior treatment with lumpectomy and radiation
** Overtreatment for the majority of patients
** Can be performed in skin-sparing or nipple-sparing fashion if desired
** Does not improve overall survival compared to breast-conserving therapy, but does improve recurrence rate from 1-2% per year to 1-2% lifetime
* Breast-conserving therapy with radiotherapy
** Will require localisation
** Specimen oriented and x-rayed
** Radiation significantly decreases local recurrence risk but does not improve survival
*** Decreased recurrence rate from 30.8% to 14.9%
*** Decreased ipsilateral invasive cancer rate from 16.4% to 7.1%
* Breast-conserving therapy without radiotherapy
** Best for lower-risk cohorts or patient preference
** Proposed low-risk cohort: (however, these results were not validated, and probably still would have a lower risk of recurrence if they had radiotherapy; the effect size is just lower) - note this is low-grade on the Van Nuys prognostic index
*** Low DCIS nuclear grade
*** Small lesion (<1.4cm)
*** Age >60
*** Surgical margins >1cm