Screen detected ductal carcinoma in situ (DCIS): overdiagnosis or an obligate precursor of invasive disease?

OBJECTIVES:Ductal carcinoma in situ (DCIS) represents 20%–25% of malignancy detected at mammographic screening. This study aims to clarify the value of detecting DCIS at mammographic screening by assessing its biological characteristics and by comparing screen detected DCIS with a series of symptomatic DCIS lesions. METHODS:222 Screen detected and 151 symptomatic cases of pure DCIS were identified. Their histological grade and the prevalence of necrosis were ascertained and compared. RESULTS:Of the screen detected lesions 28 (13%) were low grade, 40 (18%) intermediate grade, and 153 (69%) high grade. Of screen detected lesions 186 (87%) were necrotic and 29 (13%) were not. Of the 151 symptomatic lesions 24 (16%) were low grade, 34 (23%) intermediate grade, and 89 (61%) high grade. Of symptomatic lesions 112 (75%) were necrotic and 36 (24%) were not necrotic. Screen detected DCIS was more often necrotic (p=0.008) than symptomatic DCIS. CONCLUSIONS:As most DCIS detected at screening is high grade and necrotic, aggressive investigation of suspicious microcalcification at mammographic screening is advocated. Given the biological features of screen detected DCIS, the existence of an upper limit for the detection of DCIS by the NHS breast screening programme seems to be inappropriate. 8

[1]  I. Ellis,et al.  Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. , 2002, Histopathology.

[2]  I. Ellis,et al.  Digital imaging improves upright stereotactic core biopsy of mammographic microcalcifications. , 2000, Clinical radiology.

[3]  F. Alexander,et al.  The natural history of breast carcinoma , 2000, Cancer.

[4]  M. Silverstein,et al.  The prognostic significance of amplification and overexpression of c‐met and c‐erb B‐2 in human gastric carcinomas , 2000, Cancer.

[5]  L. Tabár,et al.  The natural history of breast carcinoma , 1999, Cancer.

[6]  J Costantino,et al.  Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight‐year update of Protocol B‐17 , 1999, Cancer.

[7]  R. Warren,et al.  Changing to core biopsy in an NHS breast screening unit. , 1997, Clinical radiology.

[8]  W. P. Evans,et al.  Comparison of the relative incidence of impalpable invasive breast carcinoma and ductal carcinoma in situ in cancers detected in patients older and younger than 50 years of age. , 1997, Radiology.

[9]  C. Quinn,et al.  Invasive ductal carcinoma accompanied by ductal carcinoma in situ (DCIS): comparison of DCIS grade with grade of invasive component , 1997 .

[10]  L. Liberman,et al.  Stereotactic core biopsy of calcifications highly suggestive of malignancy. , 1997, Radiology.

[11]  R. Mansel,et al.  A critical appraisal of six modern classifications of ductal carcinoma in situ of the breast (DCIS): correlation with grade of associated invasive carcinoma , 1996, Histopathology.

[12]  M. Silverstein,et al.  A prognostic index for ductal carcinoma in situ of the breast , 1996, Cancer.

[13]  W. Dupont,et al.  Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy , 1995, Cancer.

[14]  M. J. Silverstein,et al.  Prognostic classification of breast ductal carcinoma-in-situ , 1995, The Lancet.

[15]  Philip Smith,et al.  Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. , 1994, Seminars in diagnostic pathology.

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

[17]  M. J. van de Vijver,et al.  Ductal carcinoma in situ: a proposal for a new classification. , 1994, Seminars in diagnostic pathology.

[18]  S. Pinder,et al.  Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. , 1994, AJR. American journal of roentgenology.

[19]  I. Ellis,et al.  Screening-detected and symptomatic ductal carcinoma in situ: mammographic features with pathologic correlation. , 1994, Radiology.

[20]  D N Poller,et al.  Ideas in pathology. Ductal carcinoma in situ of the breast: a proposal for a new simplified histological classification association between cellular proliferation and c-erbB-2 protein expression. , 1994, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[21]  D. Schultz,et al.  Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast‐conserving surgery and definitive irradiation correlation of pathologic parameters with outcome of treatment , 1993, Cancer.

[22]  U. Chetty,et al.  Noninvasive ductal carcinoma of the breast: the relevance of histologic categorization. , 1993, Human pathology.

[23]  H. Thornton,et al.  Ductal carcinoma-in-situ of the breast , 1992, The Lancet.

[24]  K. Boo-Chai,et al.  Mammographic screening and mortality from breast cancer: The Malmo mammographic screening trial , 1990 .

[25]  J. Hendriks,et al.  Extent, distribution, and mammographic/ histological correlations of breast ductal carcinoma in situ , 1990, The Lancet.

[26]  J. Peterse,et al.  IN-SITU BREAST CANCER: THE EORTC CONSENSUS MEETING , 1989, The Lancet.

[27]  C. Smart,et al.  Implications from seer data on breast cancer management , 1978, Cancer.

[28]  Dockerty Mb,et al.  COMEDOCARCINOMA of the breast. , 1955, Cancer bulletin.

[29]  A. Monteiro.  [Comedocarcinoma of the breast]. , 1946, Anais brasileiros de ginecologia.