The incidence of ductal carcinoma in situ (DCIS) has considerably risen since the introduction of organized mammography screening programs in the general population. Currently, all DCIS are treated surgically, though most are believed to be indolent. The difficulty in determining which lesions are at risk of becoming invasive has likely led to overtreatment for many patients as well as confusion about the actual risk of developing invasive disease or dying from breast cancer. This misperception of risk has generated significant psychological stress for patients. In order to improve their quality of life, it is crucial to better understand the development of invasive breast cancers and enhance communication between doctors and patients. Some experts are even questioning the current terminology: Should DCIS still be referred as a form of cancer?
To address these issues, new research focusing on molecular, genetic, and microenvironmental aspects of DCIS progression to invasive breast cancer must be initiated. The identification of reliable biomarkers will likely allow for the development of accurate risk prediction that are models specific to DCIS, paving the way towards therapeutic de-escalation. Additionally, this research is likely to support the creation of communication and decision-support tools with treatments being primarily focused on the patient's needs.
Keywords
DCIS, breast, over-diagnosis, overtreatment, risk perception, terminology change, active surveillance, risk prediction models