Detection and Treatment of Ductal Carcinoma In Situ of the Breast-Reply

In Reply.  —We described the recent "epidemic" of DCIS, a breast lesion for which detection has increased with increased mammography utilization. Most reporters grasped the essential message that the increased detection of DCIS poses a clinical enigma and has probably resulted in considerable overtreatment. (Headlines ranged from "Ability to Find a Tiny Tumor Poses a Dilemma" in the New York Times to "Some Breast Cancer May Be Overtreated" in USA Today.)There are no good data on the extent to which DCIS in young women leads to invasive cancer in older women. We did not suggest that "these lesions are best left undetected" but did say that, "if a large proportion of cases of DCIS never become clinically apparent or life-threatening, it may be that many if not most women with mammographically detected DCIS will not benefit from treatment." Assuming that some women with DCIS eventually have their tumors progress to invasive