Ductal carcinoma in situ of the breast: understanding the misunderstood stepchild.

Understanding ductal carcinoma in situ (DCIS) of the breast has lagged behind our understanding of other elements of breast cancer. 1 Indeed, from its first description in the 1930s up through the 1950s, 2,3 reported cases were palpable and were not strictly "noninvasive" as a diagnosis of DCIS now requires. These palpable lesions were usually of high-grade histology (comedo) and had a better prognosis than invasive carcinomas, as first stated by Bloodgood. 2 These specimens of DCIS in the premammographic era were not amenable to local excision. As mammography was introduced and DCIS was detected in smaller and noncomedo forms, beliefs regarding the extensiveness and multicentricity of DCIS derived from the premammographic era persisted in the mammographic age because the term for the "new" and very different, smaller, and low-grade lesions remained the same, "DCIS." See also p 913. Even after two large cohort studies 4,5 began to help us

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