Breast ductal carcinoma in situ: Epidemiology, clinical manifestations, and diagnosis
- Laura C Collins, MD
Laura C Collins, MD
- Professor of Pathology
- Harvard Medical School
- Vice Chair of Anatomic Pathology
- Beth Israel Deaconess Medical Center, Boston
- Christine Laronga, MD, FACS
Christine Laronga, MD, FACS
- Moffitt Cancer Center, University of South Florida
- Julia S Wong, MD
Julia S Wong, MD
- Assistant Professor of Radiation Oncology
- Harvard Medical School
- Section Editors
- Lori J Pierce, MD
Lori J Pierce, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- University of Michigan School of Medicine
- Daniel F Hayes, MD
Daniel F Hayes, MD
- Section Editor — Breast Cancer
- Professor of Medicine
- University of Michigan School of Medicine
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions confined to the breast ducts and lobules that differ in histologic appearance and biological potential. The diagnosis has increased dramatically with the introduction of breast cancer screening mammography . The goal of therapy of DCIS is to prevent the occurrence of an invasive breast cancer.
The incidence of DCIS markedly increased from 5.8 per 100,000 women in the 1970s to 32.5 per 100,000 women in 2004 and then reached a plateau [1-3]. Approximately 25 percent of breast cancers diagnosed in the United States (US) are DCIS , and over 60,000 women will be diagnosed in the US alone in 2015 . This increase is attributed primarily to the utilization of breast cancer screening by mammography.
DCIS is less common than invasive breast cancer, but, like with invasive breast cancer, the risk increases with age. DCIS is uncommon in women younger than 30. The rate of DCIS increases with age from 0.6 per 1000 screening examinations in women aged 40 to 49 years to 1.3 per 1000 screening examinations in women aged 70 to 84 years [1,6]. Risk of development of metastases and/or death in a patient diagnosed with pure DCIS is rare (<1 percent) .
Mammographic screening — The widespread adoption of mammographic screening in the US, Europe, and other high-income countries dramatically increased the number of cases of DCIS. More than 90 percent of all cases of DCIS are detected only on imaging studies . (See "Screening for breast cancer: Strategies and recommendations".)
Risk factors — The risk factors for DCIS and invasive breast cancer are similar and include family history of breast cancer, increased breast density, obesity, and nulliparity or late age at first birth [9-13]. DCIS is also a component of the inherited breast-ovarian cancer syndrome defined by deleterious mutations in BRCA1 and BRCA2 genes; mutation rates are similar to those for invasive breast cancer .
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- Mammographic screening
- Risk factors
- CLINICAL MANIFESTATIONS
- Patient presentation
- Imaging studies
- - Mammography
- - Role of magnetic resonance imaging
- - Role of tomosynthesis
- Pathologic diagnostic criteria
- DIAGNOSTIC EVALUATION
- Core biopsy
- Wire localization and excision
- DIFFERENTIAL DIAGNOSIS
- Microinvasive carcinoma
- Atypical ductal hyperplasia
- Lobular carcinoma in situ
- POSTDIAGNOSTIC EVALUATIONS
- TNM staging
- Risk assessment for hereditary breast cancer
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS