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Intraductal carcinoma of the breast, also called ductal carcinoma in situ, is a breast cancer that occurs within the breast ducts and has not yet begun to invade the surrounding tissues. Historically, this, like other breast cancers, was treated by mastectomy. However, it has become common to treat intraductal carcinoma of the breast with conservative surgery, followed by irradiation to destroy any cells that might have escaped surgical extirpation. Unfortunately, breast cancer may recur even after many years. It is important, therefore, to evaluate any breast cancer treatment over a long period to gain accurate insight into its effectiveness. Such an evaluation has now been completed; the cases of 259 women treated for intraductal breast cancer were followed-up for an average of 78 months. The actuarial 10-year survival rate was 94 percent, though it should be emphasized that not all the remaining six percent of patients died of cancer. The survival specific for breast cancer was 97 percent over the same period. Recurrences were not rare, however. The 10-year rate of recurrence of cancer within the breast itself was 16 percent, and in the present group of women the recurrences occurred after intervals ranging from 17 to 129 months after the initial treatment. Twenty-four of the 28 women who developed recurrent cancer in the breast were successfully treated; four, however, developed metastatic cancer in distant parts of the body, an essentially incurable condition. The results demonstrate that a high rate of overall survival can be achieved with conservative surgery and irradiation in the treatment of intraductal carcinoma of the breast. However, the results also demonstrate that breast cancer can recur even after long periods of apparent freedom from cancer. Therefore, it is important that breast cancer patients be provided with prolonged and careful follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ductal carcinoma in situ (DCIS) is a breast cancer arising in the ducts that has not yet invaded surrounding tissue. In the past, the specter of breast cancer was sufficiently ominous that virtually all cases of DCIS were treated with mastectomy. This treatment has been reviewed in recent years, in no small part due to the fact that the growth of mammography is turning up larger numbers of DCIS than were ever diagnosed at such an early stage in the past. Breast-conserving surgery is becoming more popular, but experience with breast-conserving surgery for DCIS is still limited. For this reason, the authors report their experience treating DCIS with conservative surgery and radiation therapy during the period from 1976 to 1985. During this period, 38 patients were diagnosed at a median age of 49 years. In 20 of the patients, the tumor was detectable only by mammography. The tumor was surgically removed in all patients and the tumor bed was treated with an average dose of 6,400 cGy of radiation. An important aspect of the treatment of DCIS is the success of salvage treatment if the cancer recurs after the initial surgery and radiotherapy. In the present study, the cancer recurred in eight patients. These patients underwent mastectomy, and all but one are presently free of disease after a follow-up ranging from 1 to 73 months. Reported local recurrence rates for DCIS after mastectomy range from 0 to 2 percent. Mastectomy, therefore, remains the ''gold standard'' against which other treatments are compared. Only the patient can decide how to balance the small but real risks with the palpable benefits of breast-conserving surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)