What to Consider After Diagnosing a Patient with Ductal Carcinoma in Situ?

While ductal carcinoma in situ (DCIS) is a pre-cancerous diagnosis, it remains a hot topic of discussion among radiation oncologists. At the 2026 American College of Radiation Oncologists (ACRO) Summit, Jean L. Wright, MD, FASTRO, delivered a presentation titled “Updates and Best Practices for DCIS”, which highlighted new research in DCIS. Wright, the chair of the radiation oncology department, as well as a professor, at the University of North Carolina School of Medicine, spoke with CancerNetwork® in the wake of her presentation.

The discussion began with Wright putting the diagnosis into context. DCIS is a non-obligate precursor to invasive disease; it does not guarantee that all patients who are diagnosed with DCIS will develop invasive disease. As there are a multitude of treatment options available in DCIS, which Wright stated in an earlier portion of the interview, much of the treatment decision made stems from what the patient wishes to accomplish and how they tolerate risk. This risk refers to both recurrences as well as toxicity. Despite these risks, the range of treatment options means that there will be a reasonable option available to the patient.

Wright reiterated the importance of the patient’s perspective. As a result of this and the various treatment options, there is no perfect treatment that works for all patients; however, when choosing the right one, a physician can treat to a patient’s desires and goals.

Transcript:

What were the key takeaways from your presentation?

Well, I would say, whenever I talk about DCIS, the main thing that I always like to emphasize, and I started off at the beginning of the talk, just putting the diagnosis itself in context. This is a pre-cancerous diagnosis, or we think of it as a non-obligate precursor to invasive disease, meaning that not everybody who has a diagnosis of DCIS is ultimately going to develop invasive disease, although many will, and that it's really invasive disease that has the potential to impact survival and cause problems down the line. The first and foremost thing is just that I always reassure my patients and think about that we have a lot of options. A lot of what we decide to do depends on the patient's willingness to tolerate risk, both with respect to recurrences but also the risk of toxicities. So just having that holistic view of what the diagnosis is, and that there's going to be a range of reasonable choices, and that the patient's perspective is very, very important. For that reason, it's not like there are some cases where you're just like, “This is what we have to do.” We know that to have a good outcome, we have to do this with DCIS. There’s a lot we can consider.