Abstract：
Ductal carcinoma in situ (DCIS) accounts for 15-25% of all breast cancer diagnoses. Its prognosis is excellent overall, the main risk being the occurrence of local breast events, as most cases of DCIS do not progress to invasive cancer. Systematic screening has greatly increased the incidence of this non-obligate precursor of invasion, lending urgency to the need to identify DCIS that is prone to invasive progression and distinguish it from non-invasion-prone DCIS, as the latter can be overdiagnosed and therefore overtreated. Treatment strategies, including surgery, radiotherapy, and optional endocrine therapy, decrease the risk of local events, but have no effect on survival outcomes. Active surveillance is being evaluated as a possible new option for low-risk DCIS. Considerable efforts to decipher the biology of DCIS have led to a better understanding of the factors that determine its variable natural history. Given this variability, shared decision making regarding optimal, personalised treatment strategies is the most appropriate course of action. Well designed, risk-based de-escalation studies remain a major need in this field.
摘要：
导管原位癌（DCIS）占所有乳腺癌诊断的15-25％。其预后总体良好，主要风险是局部乳房事件的发生，因为大多数DCIS病例不会进展为浸润性癌。系统的筛查大大增加了这种非强制性入侵前兆的发生率，迫切需要识别容易发生侵袭性进展的DCIS，并将其与非侵袭性DCIS区分开来，因为后者可能被过度诊断，因此被过度治疗。治疗策略,包括手术,放射治疗,和可选的内分泌治疗，降低当地事件的风险，但对生存结果没有影响。主动监测正在被评估为低风险DCIS的可能新选择。破译DCIS生物学的大量努力使人们更好地了解了决定其可变自然历史的因素。鉴于这种可变性，关于最优的共享决策，个性化治疗策略是最合适的行动方案。精心设计，基于风险的降级研究仍然是这一领域的主要需求。
