• Shelley W, McCready D, Holloway C, Trudeau M, Sinclair S, Breast Cancer Disease Site Group. Management of ductal carcinoma in situ of the breast: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Sep 19. 41 p. (Evidence-based series; no. 1-10). [84 references]

Surgical Management

• Women with ductal carcinoma in situ (DCIS) of the breast who are candidates for breast conserving surgery should be offered the choice of lumpectomy or total mastectomy.
• Mastectomy with the option for reconstruction remains an acceptable choice for women preferring to maximize local control.

Radiotherapy

• Women with ductal carcinoma in situ who have undergone breast-conserving surgery should be offered adjuvant breast irradiation.
• Randomized trials of post-lumpectomy radiation versus observation in patients at relatively low risk of recurrence following surgery alone are ongoing. Until the results of those studies are available, these patients should be referred to a radiation oncologist for a thorough discussion of what is currently known about the potential benefits and toxicities of post-lumpectomy radiation in their particular situation.

Tamoxifen

• While there is some evidence to suggest that tamoxifen is effective in the reduction of ipsilateral recurrence and contralateral incidence in women with ductal carcinoma in situ, the absolute benefit is small and the evidence is conflicting.
• Women should be informed of the option of five years of tamoxifen therapy and of the potential toxicities and benefits associated with tamoxifen.

None provided

The recommendations are supported by meta-analyses, randomized controlled trials, practice guidelines, and one subgroup analysis.

• Shelley W, McCready D, Holloway C, Trudeau M, Sinclair S, Breast Cancer Disease Site Group. Management of ductal carcinoma in situ of the breast: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Sep 19. 41 p. (Evidence-based series; no. 1-10). [84 references]

Not applicable: The guideline was not adapted from another source.

1998 Jan 20 (revised 2006 Sep 19)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Breast Cancer Disease Site Group

None of the authors declared any potential or actual conflict of interest.

None available

This summary was completed by ECRI on August 19, 1999. The information was verified by the guideline developer as of September 17, 1999. This summary was updated by ECRI on July 3, 2001, July 5, 2002, July 21, 2003, and on November 30, 2006. The most recently updated information was verified by the guideline developer on January 19, 2007.