Cancer statistics: Breast cancer in situ

An estimated 60,290 new cases of breast carcinoma in situ are expected to be diagnosed in 2015, and approximately 1 in 33 women is likely to receive an in situ breast cancer diagnosis in her lifetime. Although in situ breast cancers are relatively common, their clinical significance and optimal treatment are topics of uncertainty and concern for both patients and clinicians. In this article, the American Cancer Society provides information about occurrence and treatment patterns for the 2 major subtypes of in situ breast cancer in the United States—ductal carcinoma in situ and lobular carcinoma in situ—using data from the North American Association of Central Cancer Registries and the 13 oldest Surveillance, Epidemiology, and End Results registries. The authors also present an overview of in situ breast cancer detection, treatment, risk factors, and prevention and discuss research needs and initiatives. CA Cancer J Clin 2015;65:481–495. © 2015 American Cancer Society.

[1]  P. Trott,et al.  International Classification of Diseases for Oncology , 1977 .

[2]  S J Schnitt,et al.  Interobserver Reproducibility in the Diagnosis of Ductal Proliferative Breast Lesions Using Standardized Criteria , 1992, The American journal of surgical pathology.

[3]  Eusebi,et al.  Long-term follow-up of in situ carcinoma of the breast. , 1994, Seminars in diagnostic pathology.

[4]  E. Feuer,et al.  Permutation tests for joinpoint regression with applications to cancer rates. , 2000, Statistics in medicine.

[5]  Hyune-Ju Kim,et al.  Kim H-J, Fay MP, Feuer EJ, Midthune DN, ‘ Permutation tests for joinpoint regression with applications to cancer rates’. Statistics in Medicine 2000 19:335–351 , 2001 .

[6]  T. Rebbeck,et al.  Differential expression of E-cadherin in lobular and ductal neoplasms of the breast and its biologic and diagnostic implications. , 2001, American journal of clinical pathology.

[7]  W. P. Evans,et al.  American Cancer Society Guidelines for Breast Cancer Screening: Update 2003 , 2003, CA: a cancer journal for clinicians.

[8]  D. Carter,et al.  Family History of Breast and Ovarian Cancer and the Risk of Breast Carcinoma in situ , 2003, Breast Cancer Research and Treatment.

[9]  W. Dupont,et al.  The natural history of low‐grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long‐term follow‐up , 2005, Cancer.

[10]  G. Colditz,et al.  Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy , 2005, Cancer.

[11]  Bircan Erbas,et al.  The natural history of ductal carcinoma in situ of the breast: a review , 2006, Breast Cancer Research and Treatment.

[12]  R. Severson,et al.  Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  R. Collins,et al.  Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials , 2005, The Lancet.

[14]  S. Joslyn Ductal Carcinoma in Situ: Trends in Geographic, Temporal, and Demographic Patterns of Care and Survival , 2006, The breast journal.

[15]  K. Malone,et al.  Risk of invasive breast carcinoma among women diagnosed with ductal carcinoma in situ and lobular carcinoma in situ, 1988‐2001 , 2006, Cancer.

[16]  Eric J Feuer,et al.  The decrease in breast-cancer incidence in 2003 in the United States. , 2007, The New England journal of medicine.

[17]  D. Miglioretti,et al.  Association between Breast Density and Subsequent Breast Cancer Following Treatment for Ductal Carcinoma In situ , 2007, Cancer Epidemiology Biomarkers & Prevention.

[18]  M. Yaffe,et al.  American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography , 2007, CA: a cancer journal for clinicians.

[19]  Jun Yao,et al.  Regulation of in situ to invasive breast carcinoma transition. , 2008, Cancer cell.

[20]  T. Tuttle,et al.  Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  J. Elmore,et al.  Communication between patients and providers and informed decision making. , 2010, Journal of the National Cancer Institute. Monographs.

[22]  R. Kane,et al.  Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. , 2010, Journal of the National Cancer Institute.

[23]  P. Ganz Quality-of-life issues in patients with ductal carcinoma in situ. , 2010, Journal of the National Cancer Institute. Monographs.

[24]  K. Kerlikowske,et al.  Changes in invasive breast cancer and ductal carcinoma in situ rates in relation to the decline in hormone therapy use. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  D. Allred,et al.  Ductal carcinoma in situ: terminology, classification, and natural history. , 2010, Journal of the National Cancer Institute. Monographs.

[26]  R. Peto,et al.  Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. , 2010, Journal of the National Cancer Institute. Monographs.

[27]  M. Silverstein,et al.  Choosing treatment for patients with ductal carcinoma in situ: fine tuning the University of Southern California/Van Nuys Prognostic Index. , 2010, Journal of the National Cancer Institute. Monographs.

[28]  J. Costantino,et al.  The impact of systemic therapy following ductal carcinoma in situ. , 2010, Journal of the National Cancer Institute. Monographs.

[29]  W. McCaskill-Stevens,et al.  Carcinoma in situ outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials. , 2010, Journal of the National Cancer Institute. Monographs.

[30]  Edi Brogi,et al.  Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  E. Hwang,et al.  The impact of surgery on ductal carcinoma in situ outcomes: the use of mastectomy. , 2010, Journal of the National Cancer Institute. Monographs.

[32]  F. O'Malley,et al.  Lobular neoplasia: morphology, biological potential and management in core biopsies , 2010, Modern Pathology.

[33]  R. Kane,et al.  Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ. , 2010, Journal of the National Cancer Institute. Monographs.

[34]  C. Lawton,et al.  Local Excision Alone Without Irradiation for Ductal Carcinoma In Situ of the Breast: A Trial of the Eastern Cooperative Oncology Group , 2010 .

[35]  K. Polyak,et al.  The microenvironment in breast cancer progression: biology and implications for treatment , 2011, Breast Cancer Research.

[36]  L. Bernstein,et al.  Disparities in Reconstruction Rates after Mastectomy for Ductal Carcinoma in Situ (DCIS): Patterns of Care and Factors Associated with the Use of Breast Reconstruction for DCIS Compared with Invasive Cancer , 2011, Annals of Surgical Oncology.

[37]  Narasimhan P. Agaram,et al.  Atypical ductal hyperplasia: interobserver and intraobserver variability , 2011, Modern Pathology.

[38]  C. D’Este,et al.  Patient Perception , Preference and Participation Knowledge , satisfaction with information , decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ ( DCIS ) § , 2011 .

[39]  D. Hanahan,et al.  Hallmarks of Cancer: The Next Generation , 2011, Cell.

[40]  R. Kane,et al.  Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis , 2011, Breast Cancer Research and Treatment.

[41]  T. Julian,et al.  Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. , 2011, Journal of the National Cancer Institute.

[42]  K. Bland William Hunter Harridge Lecture: Contemporary management of pre-invasive and early breast cancer. , 2011, American journal of surgery.

[43]  J. Cuzick,et al.  Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial , 2010, The Lancet. Oncology.

[44]  H. Kuerer,et al.  Biological Markers in DCIS and Risk of Breast Recurrence: A Systematic Review , 2011, Journal of Cancer.

[45]  Karen A Gelmon,et al.  Exemestane for breast-cancer prevention in postmenopausal women. , 2011, The New England journal of medicine.

[46]  J. Thigpen Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24 , 2012 .

[47]  T. Eberlein Radiation Therapy for Ductal Carcinoma In Situ: A Decision Analysis , 2012 .

[48]  J. Ockene,et al.  Effects of menopausal hormone therapy on ductal carcinoma in situ of the breast , 2013, Breast Cancer Research and Treatment.

[49]  S. Fletcher,et al.  Ten-year risk of diagnostic mammograms and invasive breast procedures after breast-conserving surgery for DCIS. , 2012, Journal of the National Cancer Institute.

[50]  J. Elmore,et al.  Challenges in ductal carcinoma in situ risk communication and decision‐making , 2012, CA: a cancer journal for clinicians.

[51]  J. Elmore,et al.  Ductal carcinoma in situ (DCIS): raising signposts on an ill-marked treatment path. , 2012, Journal of the National Cancer Institute.

[52]  V. Beral,et al.  Comparison of the effects of genetic and environmental risk factors on in situ and invasive ductal breast cancer , 2012, International journal of cancer.

[53]  Sunil R. Lakhani,et al.  WHO classification of tumours of the breast , 2012 .

[54]  T. Julian,et al.  Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[55]  J. Dixon,et al.  Endocrine Therapy in DCIS: How Do We Proceed? , 2012, The breast journal.

[56]  T. Sørlie,et al.  Molecular subtypes in ductal carcinoma in situ of the breast and their relation to prognosis: a population-based cohort study , 2013, BMC Cancer.

[57]  George W. Sledge,et al.  A Multigene Expression Assay to Predict Local Recurrence Risk for Ductal Carcinoma In Situ of the Breast , 2013, Journal of the National Cancer Institute.

[58]  H. Bartelink,et al.  Breast-conserving treatment with or without radiotherapy in ductal carcinoma In Situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[59]  W. McCaskill-Stevens,et al.  Preliminary results of centralized HER2 testing in ductal carcinoma in situ (DCIS): NSABP B-43 , 2013, Breast Cancer Research and Treatment.

[60]  I. Ellis,et al.  Lobular Neoplasia of the Breast Revisited With Emphasis on the Role of E-Cadherin Immunohistochemistry , 2013, The American journal of surgical pathology.

[61]  J. Cuzick,et al.  Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[62]  Andrew H. Beck,et al.  Mammographic density and risk of breast cancer by age and tumor characteristics , 2013, Breast Cancer Research.

[63]  Sook-Young Woo,et al.  Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast , 2013, The British journal of surgery.

[64]  C. Mathers,et al.  GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer , 2013 .

[65]  A. Recht Are the randomized trials of radiation therapy for ductal carcinoma in situ still relevant? , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[66]  R. Jagsi,et al.  Social and Clinical Determinants of Contralateral Prophylactic Mastectomy. , 2014, JAMA surgery.

[67]  Julian Peto,et al.  Genetic Predisposition to In Situ and Invasive Lobular Carcinoma of the Breast , 2014, PLoS genetics.

[68]  L. Holmberg,et al.  Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[69]  J. Harvey,et al.  Pleomorphic lobular carcinoma in situ of the breast: Can the evidence guide practice? , 2014, World journal of clinical oncology.

[70]  Derek C. Radisky,et al.  Understanding the Premalignant Potential of Atypical Hyperplasia through Its Natural History: A Longitudinal Cohort Study , 2014, Cancer Prevention Research.

[71]  J. Cuzick,et al.  Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial , 2014, The Lancet.

[72]  Joann G Elmore,et al.  Mammographic performance in a population-based screening program: before, during, and after the transition from screen-film to full-field digital mammography. , 2014, Radiology.

[73]  Karthik Devarajan,et al.  Identifying a Highly-Aggressive DCIS Subgroup by Studying Intra-Individual DCIS Heterogeneity among Invasive Breast Cancer Patients , 2014, PloS one.

[74]  D. Winchester,et al.  Breast conserving therapy for DCIS—Does size matter? , 2014, Journal of surgical oncology.

[75]  P. Porter,et al.  Use of menopausal hormone therapy and risk of ductal and lobular breast cancer among women 55–74 years of age , 2014, Breast Cancer Research and Treatment.

[76]  S. Shak,et al.  Abstract S5-04: A large prospectively-designed study of the DCIS score: Predicting recurrence risk after local excision for ductal carcinoma in situ patients with and without irradiation , 2015 .

[77]  Karla Kerlikowske,et al.  Trends in breast biopsy pathology diagnoses among women undergoing mammography in the United States: A report from the Breast Cancer Surveillance Consortium , 2015, Cancer.

[78]  S. Shak,et al.  A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone , 2015, Breast Cancer Research and Treatment.

[79]  L. Hartmann,et al.  Atypical hyperplasia of the breast--risk assessment and management options. , 2015, The New England journal of medicine.

[80]  Barbara L. Smith,et al.  RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[81]  David L. Page,et al.  Continued observation of the natural history of low-grade ductal carcinoma in situ reaffirms proclivity for local recurrence even after more than 30 years of follow up , 2014, Modern Pathology.

[82]  L. Norton,et al.  Current management of lesions associated with an increased risk of breast cancer , 2015, Nature Reviews Clinical Oncology.

[83]  M. Broder,et al.  The impact of genomic testing on the recommendation for radiation therapy in patients with ductal carcinoma in situ: A prospective clinical utility assessment of the 12‐gene DCIS score™ result , 2015, Journal of surgical oncology.

[84]  T. Julian,et al.  Primary results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) versus tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[85]  J. Elmore,et al.  Diagnostic concordance among pathologists interpreting breast biopsy specimens. , 2015, JAMA.

[86]  A. Chagpar,et al.  Epidemiology of Ductal Carcinoma In Situ , 2015 .