Ductal Carcinoma In Situ: A Rose by Any Other Name.

Allegheny Cancer Center, Allegheny General Hospital, Pittsburgh, PA (DLW, TBJ).
CancerSpectrum Knowledge Environment (Impact Factor: 15.16). 09/2013; DOI: 10.1093/jnci/djt268
Source: PubMed
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    ABSTRACT: Background It is controversial whether ductal carcinoma in situ (DCIS) is a preinvasive marker of breast cancer or if it is part of a spectrum of small cancers with malignant potential. Comparing clinical outcomes in women with invasive and noninvasive breast lesions might help to resolve the issue. Methods From a database of 2641 patients with breast cancer, we selected women who had been treated with breast-conserving surgery for a cancer that was 2.0 cm or less in size, node-negative, and nonpalpable. No subject received chemotherapy. Cancers were categorized as noninvasive (stage 0, n = 172) or invasive (stage 1, n = 401) based on a review of the pathology records. We compared the actuarial risks of in-breast recurrence after invasive and noninvasive breast lesions before and after adjusting for tamoxifen and radiotherapy. Results The 18-year cumulative risk of in-breast recurrence was 35.2% for patients with DCIS and 12.8% for patients with small invasive cancers (hazard ratio: 2.4; 95% confidence interval: 1.5 to 3.8; p < 0.0003). After adjustment for radiotherapy and tamoxifen treatment, the difference was small and nonsignificant (hazard ratio: 1.4; 95% confidence interval: 0.9 to 2.4; p = 0.22). Conclusions For women with small, nonpalpable, node-negative breast cancers, the likelihood of experiencing an in-breast recurrence was associated with radiotherapy and with tamoxifen, but not with the presence of cancer cells invading beyond the basement membrane.
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    ABSTRACT: This study measures the probability of development of invasive breast cancer (BC) following the diagnosis of carcinomas in situ (CIS). A 25-year prospective follow-up was conducted by linking the Canadian National Breast Screening Study (CNBSS) to cancer registries and a national vital statistics database. Subsequent BC incidence was identified in CNBSS women who were diagnosed with CIS. CIS was classified into ductal (DCIS) and lobular carcinoma in situ (LCIS). Cumulative cancer incidence probabilities were calculated and a 1:5 matched nested case control study was conducted to estimate the odds of BC development. Of the 146 women diagnosed with CIS, 26 developed invasive BC (17.8%) and 12 died of BC (8.2%). The average time from the diagnosis of CIS to invasive BC was 6.3 years (±5.6). The 20-year cumulative incidence probabilities for DCIS and LCIS were 19.0% (95%CI: 11.2, 26.8) and 21.3% (95%CI: 7.1, 35.4) respectively. The odds of development of BC in CIS women was significantly elevated compared to controls (OR=2.6, 95% CI: 1.5, 4.5). While women with CIS had a higher odds of development of BC compared to those without CIS, at 20-year post CIS diagnosis, more than 80% of them remained free of invasive BC. This low probability of developing invasive BC post CIS diagnosis does not support the notion that CIS of the breast is an obligate precursor lesion of invasive BC. © 2014 Wiley Periodicals, Inc.
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