Reframing treatment for ductal carcinoma in situ: could less be more?

In a typical breast surgery practice, nearly one-fifth of new patients present with ductal carcinoma in situ (DCIS), usually detected on mammography as an incidental finding. Most of these women are otherwise healthy, take care of themselves, have had a mammogram as part of their routine health maintenance, and are now grappling with a “cancer” diagnosis. When explaining to patients that DCIS generally has a favorable outcome and that it rarely affects mortality, it always becomes apparent that medical and surgical professionals still have more questions than answers regarding this disease. Is DCIS cancer or not? What would happen if no treatment for DCIS were available —if patients had to wait until they developed invasive cancer before choosing to have surgery? And how do we have a conversation with patients so that we can reduce the anxiety that often motivates these women to choose a bilateral mastectomy for a noninvasive disease?