Endocrine treatment for ductal carcinoma in situ: balancing risks and benefits
Authors: Stephen R D Johnston
Journal: The Lancet (2015)

Up to 20% of all newly diagnosed breast cancers are non-invasive carcinomas, known as ductal carcinoma in situ. 1 Van Zee KJ White J Morrow M Harris J Ductal carcinoma in situ and microinvasive breast cancer. in: Harris JR Lippman ME Morrow M Osborne CK Diseases of the breast. 5th edn. Wolters Kluwer Health, Philadelphia2014: 337-356 Google Scholar Surgical excision is the mainstay of management, with the addition of breast irradiation after breast-conserving surgery shown to reduce ipsilateral breast cancer recurrence in five randomised controlled trials. 1 Van Zee KJ White J Morrow M Harris J Ductal carcinoma in situ and microinvasive breast cancer. in: Harris JR Lippman ME Morrow M Osborne CK Diseases of the breast. 5th edn. Wolters Kluwer Health, Philadelphia2014: 337-356 Google Scholar Because molecular and epigenetic evidence suggests that ductal carcinoma in situ is a precursor for invasive breast cancer, an important question has been whether systemic adjuvant endocrine therapy can affect the natural history of ductal carcinoma in situ, especially given its role in reducing recurrence and preventing contralateral disease and improving overall survival in patients with oestrogen-receptor (ER) positive invasive breast cancer. 2 Early Breast Cancer Trialists' Collaborative Group (EBCTCG)Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 365: 1687-1717 Summary Full Text Full Text PDF PubMed Scopus (6410) Google Scholar Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trialCompared with tamoxifen, anastrozole treatment provided a significant improvement in breast cancer-free interval, mainly in women younger than 60 years of age. This finding means that women will benefit from having a choice of effective agents for ductal carcinoma in situ. Full-Text PDF Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trialGiven the similar efficacy of tamoxifen and anastrozole for women older than age 60 years, decisions about treatment should be informed by the risk for serious adverse health effects and the symptoms associated with each drug. For women younger than 60 years old, treatment decisions might be driven by efficacy (favouring anastrozole); however, if the side-effects of anastrozole are intolerable, then switching to tamoxifen is a good alternative. Full-Text PDF Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trialThird-generation aromatase inhibitors are more effective than tamoxifen for preventing recurrence in postmenopausal women with hormone-receptor-positive invasive breast cancer. However, it is not known whether anastrozole is more effective than tamoxifen for women with hormone-receptor-positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole with that of tamoxifen in postmenopausal women with hormone-receptor-positive DCIS. Full-Text PDF Open Access