Risk of invasive carcinoma among women diagnosed with ductal carcinoma in situ and lobular carcinoma in situ 1988–2001

Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Epidemiology Program, Seattle, Washington
Cancer (Impact Factor: 4.89). 05/2006; 106(10):2104 - 2112. DOI: 10.1002/cncr.21864


Incidence rates of ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) have been rising, but little is known about which patients will develop invasive breast cancer or what types of tumors these patients may develop.METHODS
By using Surveillance, Epidemiology and End Results (SEER) data, the authors evaluated how types of invasive breast cancers diagnosed among 37,692 DCIS and 4490 LCIS patients differed and how clinical characteristics influenced subsequent breast cancer risk.RESULTSAmong DCIS patients, incidence rates of ipsilateral and contralateral invasive breast cancer were 5.4/1000 person-years and 4.5/1000 person-years, respectively; and among LCIS patients, incidence rates were 7.3/1000 person-years and 5.2/1000 person-years, respectively. LCIS patients were 5.3-fold more likely than DCIS patients to develop invasive lobular carcinomas. Women whose DCIS had comedo histologic features or was poorly differentiated had 1.4-fold and 2.0-fold elevations in ipsilateral invasive breast cancer risk. Furthermore, among DCIS patients, 20-49 year-olds and black women and Hispanic white women had 1.6, 2.7, and 2.3-fold elevated risks of Stage III/IV breast cancer compared with 50-59 year-olds and non-Hispanic whites, respectively.CONCLUSIONS
Screening young DCIS patients more frequently and improving the follow-up care of blacks and Hispanic whites with DCIS may reduce their risk of advanced-stage breast cancer. In addition, LCIS may be a precursor rather than just an ambiguous risk factor for invasive breast cancer, and, therefore, localized treatment for LCIS may be warranted. Given that incidence rates of DCIS and LCIS have been rising, investigations of these tumors should be continued to better understand their etiology and appropriate clinical management. Cancer 2006. © 2006 American Cancer Society.

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Available from: Babette Saltzman, Dec 09, 2014
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    • "Epidemiologic studies have shown that 10–20% of patients diagnosed with LCIS will subsequently develop breast carcinoma 15–25 years after their initial diagnosis 12–15. Recent studies have also shown that the risk of developing a subsequent invasive carcinoma after the diagnosis of ALH and/or LCIS is three times more likely to occur in the ipsilateral breast than in the contralateral breast 14 and patients with ALH or LCIS have an overrepresentation of developing invasive lobular carcinoma when compared with the general population 13,16,17. "
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    Cancer Medicine 06/2014; 3(3). DOI:10.1002/cam4.223 · 2.50 Impact Factor
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    • "Therefore, lobular lesions may be at greater risk to develop invasion and metastasis to lymph node. This speculation is consistent with a case control study of 37,692 ductal carcinoma in situ (DCIS) and 4,490 lobular carcinoma in situ (LCIS), which showed that patients with LCIS were 5.3-fold more likely than patients with DCIS to develop invasive lobular lesions 41. Due to the above reasons, invasive and metastatic lobular lesions may have lower potential to initiate new tumor nests in new sites. "
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    ABSTRACT: Invasive lobular cancer (ILC) tends to be significantly larger in size with significantly more positive lymph nodes, whereas ILC has a significantly more favorable outcome, compared to stage-matched invasive ductal carcinoma (IDC). The mechanism accounting for such differences remains elusive. Based on morphological, immunohistochemical, and molecular studies of over 1,000 cases of human breast cancers, we hypothesize that the differences may result from the structural and/or functional differences of their surrounding myoepithelial cell layers, which dictate lobular and ductal tumor cells to follow different pathways of invasion or metastasis. The background, rationale, supportive data, and implications of our hypothesis are presented and discussed.
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    • "embolization). These findings regarding the different patterns of stromal matrix proteoglycans could amplify the debate on the biology of in situ carcinomas: even if the knowledge of the evolution of the various histotypes is still contradictory , and the related risk of developing invasive carcinomas is not clearly assessed [20] [21] [22], our data seem to prove that the mechanisms of cell–stroma interactions leading to the development of invasive lesions follow different pathways in the various histotypes of in situ breast lesions. "
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