Expert pathologic review is required in all cases.

Current treatment options for LCIS:

observation Chemoprevention with tamoxifen Bilateral total mastectomy

DCIS:
With DCIS and evidence of Extensive disease (>4cm of disease in more than one quadrant) usually require mastectomy Limited disease: Lumpectomy and radiation therapy

Low grade DCIS of the solid, cribriform, or papillary subtype that is <0.5cm in diameter may be managed by lumpectomy alone without radiation if the margins of resection are widely free of disease.

Mastectomy with assessment of axillary lymph node status and breast conserving surgery w/ assessment of axillary lymph node status and radiation therapy for stages I and II. Breast Conservation is considered. Relative Contraindications: prior radiation therapy to the breast or chest wall, involved surgical margins or unknown margin status after re-excision, multicentric disease, scleroderma or lupus erythematosus

Candidates for Sentinel lymph node dissection: uninvolved axillary lymph node status in women w/ T1 or T2 primary breast CA. Adjuvant chemotherapy: early invasive with node + cancers, cancers that are >1cm, node negative cancers of >0.5cm when adverse prognostic features are present. Adverse Prognostic factors: blood vessel or lymph vessel invasion, high nuclear grade, high histologic grade, her2/neu overexpression, negative hormone receptor status

Tamoxifen for hormone receptor postive cancers that are >1cm Trastuzumab- the only targeted agent that is currently approved for use in the metastatic and the adjuvant setting.

Surgery with radiation therapy and chemotherapy. Locally advanced stage III: Neoadjuvant chemotherapy as initial mgt Surgical therapy for stage III: Modified Radical Mastectomy followed by adjuvant radiation Stage IIIA, minimal response to Chemotherapy and for Stage IIIB: Neoadjuvant can decrease the local-regional cancer burden enough to permit subsequent radical mastectomy

Hormonal therapies
Candidates: hormone receptor + cancers, w/ bone or soft tissue metastases, w/ limited and asymptomatic visceral metastases

Systemic chemotherapy :hormone receptor negative, symptomatic visceral metastases, hormone refractory metastases w/ Bone metastases: Bisphosphonates may be given