In light of the recent article in the ny times on breast cancer would you recommend surgery for a 90 year old woman recently diagnosed with dcis?

Not enough info: Disclaimer: I'm a geriatrician, not a (surgical) oncologist. However, as I work closely w/our elderly, I would heartily recommend reading its follow up (http://www.nytimes.com/2015/08/21/health/breast-cancer-treatment-and-dcis-readers-react.html) then discussing w/her FamilyDoc. Answer depends upon her healthcare goals, overall health, mental health (any dementia?), heart & lung health etc.

Not necessary unless: Unless there is a palpable lump, this area of the breast can be monitored by your doctor and surgery held back. , it is an option in the future but only if the lump is growing in size both from your own impression(breast self examination should be done once monthly) and get a mammogram once every 6 months. There is no rush for surgery.

Depends: Depends on how good she is at 90 yrs and the size, type of DCIS. "Good-risk" DCIS has small size, low aggressive, and good-looking under microscope. You can leave it alone without surgery. "High-risk" DCIS has large size, aggressive, or ugly-looking. So, surgery (wide excision) may be considered if she functions well. However, radiation or tamoxifen is neither needed nor helpful in elderly.

Maybe: It depends on the size of the area with DCIS and the patient's overall health. If the area of DCIS is large and palpable then I am worried that the area may erode into skin. If patient healthy enough then I would remove a palpable mass, even DCIS. If the patient is frail and the DCIS is small, I would do nothing because at that age she is more likely to die from something other than cancer

No, but give choice: The most extensive study of 100,000 pts with DCIS followed over 20 years, the risk of dying , about 3.3 percent was very low, between the group that had lumpectomies with or without radiation and the group that had mastectomies.That said, a young 90 year old,wishing 110 span(OK?), need to be given a choice,since aggressive DCIS upped risk to just 7.8% in 20 yrs,so some opt for no tx,but close ffup