De-escalation in DCIS Care
Purpose of Review: Standard DCIS management consists of surgery with consideration of adjuvant radiation and endocrine therapy. However, widespread recognition of the overdiagnosis and overtreatment burden in DCIS has led to a reevaluation of this standard. The purpose of this review is to summarize the foundational clinical trials in DCIS and to discuss ongoing efforts in treatment de-escalation. Recent Findings: Standard of care DCIS management is based on large high-quality randomized clinical trials. The results of those trials have been durable over more than a decade of follow-up. However, we now better appreciate that DCIS is a heterogeneous disease with variable risk of progression. Clinicopathologic and molecular tools are helping better define which patients with DCIS would benefit from de-escalation. Modern clinical trials have proven the safety of shorter and lower dose radiation regimens in low-risk patients, and results from active monitoring trials are highly anticipated. In addition, decision support tools, shared decision-making, and molecular testing promise to help guide patients through an increasingly complex decision-making process. Summary: Current treatment of DCIS has moved towards successful de-escalation of treatment for those patients with low risk of progression. Further incorporation of molecular tools will allow for personalized treatment based on individual risk and preferences.
Duke Scholars
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- 3211 Oncology and carcinogenesis
- 1112 Oncology and Carcinogenesis
Citation
Published In
DOI
EISSN
ISSN
Publication Date
Volume
Issue
Start / End Page
Related Subject Headings
- 3211 Oncology and carcinogenesis
- 1112 Oncology and Carcinogenesis