Multiple Choice Questions

1. Unlike invasive breast cancer treatment options, there is a lack of well-designed clinical trials and evidence to guide the physician in the treatment of DCIS
   
2. DCIS, much like lobular carcinoma in situ (LCIS), is more of a marker of breast cancer risk than a “cancer disease entity”
   
3. Local treatment options for DCIS result in different local recurrence risks in the index breast, but have no impact on survival of the DCIS patient, which remains extremely high

For almost all clinical trials that evaluate treatment options for cancer, “survival” and “cancer-free survival” are endpoints that matter the most to both the patients and the trial investigators. Because only the risk of developing a local failure is modified with a given DCIS treatment, the decision to treat or not to treat is perceived differently by women and their doctors, resulting in much more controversy than the management of invasive early breast cancer. A study from the University of Michigan demonstrates this issue.

1. In mammography screening programs, DCIS accounts for about 25% of all newly diagnosed breast cancers
   
2. The most common presentation of DCIS on mammography is microcalcifications
   
3. If taken as a separate entity, DCIS is the fourth leading cancer, after invasive breast, lung, and colon cancer
   
4. All of the above

Because of the number of women in the United States who undergo screening mammography on a regular basis, DCIS is diagnosed far more commonly than in countries without a screening program in place.

1. Fine-needle aspiration
   
2. Stereotactic core biopsy
   
3. Surgical biopsy using wire localization

Multiple professional organizations, including pathologists and surgeons, endorse stereotactic core biopsy as the preferred method of obtaining tissue from a mammographic abnormality; the core specimen provides good architectural information and avoids surgery until the diagnosis is established.

1. True
   
2. False

The NSABP Cooperative Group has consistently used the definition of “no tumor on ink” as their definition of a clear margin. When looking at pathology slides, this definition is workable and clear. But there are little con­sistent data supporting other “ideal” margin widths for DCIS. In part, this is because the processing of the tissue in the pathology lab, meticulous as it is, actually samples only a small proportion of each submitted block. Thus, hypothetically, a “2 mm margin” in a given slide could be measured as “1 mm” or “3 mm,” for example, in different cuts from the same block.