Ductal Carcinoma In Situ of the Breast.

BACKGROUND: Ductal carcinoma in situ (DCIS) is detected more often since the advent of mammography. A standardized pathologic staging and grading system does not exist, but nuclear grade is assuming greater importance. The history of DCIS is long, and its treatment is a controversial issue in breast cancer today. METHODS: Data have been reviewed regarding the role of HER-2 expression as a prognostic variable, as a predictive factor for response to chemotherapy and hormonal therapies, and as a directed therapeutic target for breast cancer. RESULTS: The NSABP protocol B06 revealed a recurrence rate of 43% in patients treated with local excision alone. Half of recurrences are still DCIS, but 50% are invasive. Local control is markedly improved by the addition of radiation. Recurrence is also minimized by careful cytologic review of margins. Sentinel lymph node biopsy has resulted in more accurate nodal staging. CONCLUSIONS: As a heterogeneous lesion, DCIS may not lend itself to a uniform treatment approach. Careful analysis of resection margins is required. As our understanding of the diagnosis and treatment of this disease develops, a coordinated team approach is optimal.

Psychological Adjustment to Breast Cancer by Older Women.

Older women (over aged 63 years) surveyed six months after their breast cancer diagnosis showed the same level of psychological adjustment as younger women. Within the sample of older women, psychological distress was positively correlated with amount of life-stressors (eg, financial, family, or health problems) experienced during the year prior to diagnosis. It is hypothesized that life development stage may be a better predictor of adjustment to breast cancer than chronological age.

Management of Cancer in the Older Aged Person.

The management of cancer in the older person is an increasingly common aspect of oncologic practice. The central questions concern effectiveness and safety of antineoplastic therapy, clinical criteria to identify patients who may benefit from treatment, and individualized management plans. To address these questions, we review the influence of age on various forms of cancer treatment, explore the basis of treatment-related decisions in older persons with cancer, and propose areas for future investigation. Age itself is not a contraindication to cancer treatment. Individualized treatment plans, based on appropriate diagnosis, staging and comprehensive geriatric assessment, are most beneficial to the older patients.