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Mastectomy used to be the treatment for all forms of breast cancer. More recently, however, the trend has been to use breast-conserving surgery when possible. Since ductal carcinoma in situ (DCIS), a form of breast cancer, is wholly noninvasive, it would seem to be a prime candidate for breast-conserving surgery. Nevertheless, some patients who undergo breast-conserving therapy do experience recurrences, and often these are invasive recurrences with a very poor prognosis. Therefore, it is important to evaluate the natural history of DCIS before decisions about breast-conserving therapy can be made. This was done in a total of 208 cases of DCIS. The cancers that were removed had a variety of histological types based on microscopic evaluation. The most common was a subtype called comedocarcinoma, occurring in 105 cases; other subtypes included cribriform and macropapillary cancers. The comedocarcinoma subtypes had an eight percent rate of recurrence, significantly greater than the one percent rate of recurrence observed for the other subtypes. Furthermore, recurrences were more common among women who had received breast-conserving therapy than among those who had mastectomy. An additional finding was that the lymph nodes were free of cancer cells in the majority of patients with DCIS. These results indicate that dissection of the lymph nodes is probably not useful for patients with intraductal carcinoma. Furthermore, although breast-conserving therapy may be considered for many patients with intraductal carcinoma, it should be considered very cautiously for patients with DCIS of the comedocarcinoma subtype. (Consumer Summary produced by Reliance Medical Information, Inc.)