How is stage 0 (ductal carcinoma in situ) breast cancer treated?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Primary treatment options include the following:

  • Lumpectomy without axillary assessment, plus whole-breast radiation therapy (RT); use of radiation boost (photons, brachytherapy, or electron beam) to the tumor bed is recommended, especially in patients age ≥50 y or

  • Total mastectomy, with or without sentinel node biopsy (SNB) and with or without breast reconstruction or

  • Lumpectomy without lymph node surgery and without radiation therapy (lower-level evidence)

Considerations include the following:

  • Although axillary dissection or SNB is often not performed, SNB may be done in some cases if an initial core biopsy showed DCIS, because more extensive sampling may show invasive carcinoma

  • In the absence of risk factors for recurrence (eg, palpable mass, larger size, higher grade, close or involved margins, age < 50 y), some patients may not receive RT

  • Consider risk-reduction therapy with tamoxifen for 5 years for patients treated with lumpectomy and RT, especially those with estrogen receptor (ER)–positive DCIS


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