Journal of the National Cancer Institute Monographs, No. 41, 2010 113
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Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer that
encompasses a wide spectrum of diseases ranging from low-grade
lesions that are not life threatening to high-grade lesions that may
harbor foci of invasive breast cancer. The epidemiology of DCIS is
intertwined with that of invasive breast cancer. This article sum-
marizes information on the incidence and prevalence of DCIS and
its specific pathological subtypes, and on how incidence and preva-
lence are influenced by mode of detection, population characteris-
tics, and other risk factors. This review does not address issues of
DCIS incidence in women with a history of DCIS or breast cancer,
or predictors of second primaries or recurrence of DCIS.
Studies were sought from a wide variety of sources, including
MEDLINE via PubMed, Scirus, and Cochrane databases; websites
of the Sloane Project and of the International Breast Cancer
Screening Network; and manual searches of reference lists from
systematic reviews and consensus conferences. We include articles
published from 1965 through January 31, 2009.
We searched MESH headings, titles, and abstracts for the
terms Ductal Carcinoma In Situ, DCIS, noninfiltrating intraductal
carcinoma, carcinoma in situ, intraductal carcinoma, localized
breast cancer, and stage 0 breast cancer. We did not exclude stud-
ies by level of evidence. We reviewed abstracts to confirm eligible
target populations of female adults. We excluded studies of inva-
sive breast cancer only, non-breast cancers, and animal or in vitro
experiments and analysis of results from other publications, letters,
comments, and case reports. We abstracted 92 publications. This
article includes a highly abbreviated reference list.
The incidence of DCIS rose from 1.87 per 100 000 women from
1973–1975 to 32.5 per 100 000 in 2005 (1). This increase was
observed in all age categories with the greatest rise among those
older than 50 years of age. The increase in DCIS has not been
uniform across histological types. Comedo histology is associated
with a particularly high risk of recurrence and has been stable over
recent years, whereas low-grade DCIS, generally considered to be
less likely to recur or develop into invasive breast cancer, has
accounted for the majority of the recent increase (2) (Figure 1).
Demographic Variation in DCIS Incidence
The incidence of DCIS, like invasive breast cancer, is strongly
related to age. DCIS is extremely uncommon before age 35–39.
After that, the incidence rises steadily to a peak of 96.7 per 100 000
at ages 65–69 and then declines slowly until age 79 and steeply after
that. In contrast, invasive breast cancer peaks at age 75–79 with
incidence of 453.1 per 100 000 women (Figure 2). At no age is
DCIS more common than invasive breast cancer. Between the ages
of 40 and 64, between 21% and 22.8% of all breast cancers are
DCIS. Before age 40 and after age 64, the proportion of breast
cancers that are DCIS drops to as low as 9%. The change in inci-
dence of DCIS over time increases in all age groups but are the
greatest among women older than 50 years.
Ductal Carcinoma In Situ: Risk Factors and Impact of Screening
Beth A. Virnig, Shi-Yi Wang, Tatyana Shamilyan, Robert L. Kane, Todd M. Tuttle
Correspondence to: Beth A. Virnig, PhD, MPH, Division of Health Policy and Management, School of Public Health, University of Minnesota, A365 Mayo
(MMC 729), 420 Delaware St SE, Minneapolis, MN 55455 (e-mail: email@example.com).
Background The National Institutes of Health Office of Medical Applications of Research commissioned a structured litera-
ture review on the incidence of ductal carcinoma in situ (DCIS) as a background paper for the State of the
Science Conference on Diagnosis and Management of DCIS.
Methods Published studies were abstracted from MEDLINE and other sources. We include articles published through
January 31, 2009; 92 publications were abstracted.
Results DCIS incidence rose from 1.87 per 100 000 in 1973–1975 to 32.5 per 100 000 in 2005. Increases in incidence were
greatest in tumors without comedo necrosis. Incidence increased in all ages but more in women older than
50 years. Increased use of mammography explains some but not all of the increased incidence. Risk factors for
incident DCIS include older age and positive family history. Whereas tamoxifen prevents both invasive breast
cancer and DCIS, raloxifene is associated with decreased invasive breast cancer but not decreased DCIS.
Conclusions Scientific questions deserving further investigation include the relationship between mammography use and
DCIS incidence and the role of chemoprevention for reducing the incidence of DCIS and invasive breast
J Natl Cancer Inst Monogr 2010;41:113–116
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