Role of genetic profiling and recurrence scores in treatment planning for DCIS

Ductal carcinoma in situ (DCIS) comprises a heterogeneous group of noninvasive breast cancers. The widespread use of screening mammography, coupled with improvements in technology, has led to the identification of large numbers of women with DCIS, many of which are detected at relatively small sizes. However, significant debate surrounds the proper management of patients with DCIS who are eligible for breast-conserving therapy. Some advocate for routine use of adjuvant radiation, while others recommend only wide local excision. Most would agree that a more personalized approach is the goal. Currently, there are no standard clinicopathologic features that accurately predict which patients will experience a recurrence. Molecular profiling represents the most promising area of research to predict recurrence risk based on the individual tumor biology. In this chapter, we will review the data regarding the role of molecular diagnostics in patients with DCIS, their potential to guide treatment decisions, and their limitations to date. Further, we will discuss future directions of molecular profiling that may refine the treatment algorithm for patients diagnosed with DCIS.