Michael D. Lagios, MD

The major conclusion to bedrawn from the extensivelypublished University of SouthernCalifornia (USC)/Van Nuys databaseon ductal carcinoma in situ(DCIS) is that, to the extent that DCIScan be totally excised, the ipsilaterallocal control rate will approach 100%with surgery alone, regardless of tumorgrade or size or patient age. Thisconclusion, noted by Dr. Silverstein,was achieved only through prospectivemammographic/pathologic correlationand a meticulous pathology protocolthat required orientation, selectiveinking of margins, sequential sectioningand processing of the entirespecimen, and prospective calculationof size and margin status.

In the May, 1997, issue of Oncology News International , the updated eight-year results of NSABP protocol B-17 were reported as presented by Dr. Bernard Fisher in Paris. B-17 randomized patients with ductal carcinoma in situ (DCIS) into two groups: One group received excision only, the other excision plus postoperative radiation therapy.

Despite the results of the National Surgical Adjuvant Breast and Bowel Project B-17, there continues to be debate regarding the most appropriate treatment for patients with ductal carcinoma in situ (DCIS) of the breast. Numerous clinical, pathologic, and laboratory factors can aid clinicians and patients wrestling with the difficult