Commentary

There is a significant divergence of opinion for the preferred surgical approach to the patient with a local recurrence of DCIS. Surgeons consistently prefer mastectomy when the recurrence is invasive.

Systemic therapy in this situation is controversial, and the NSABP is considering a trial to evaluate the combination of docetaxel and capecitabine for patients with invasive recurrences. In the patient who recurs while on tamoxifen, most surgeons would continue some type of endocrine therapy. In the elderly patient, nearly a third of surgeons would prefer an aromatase inhibitor over tamoxifen.

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