The natural history of ductal carcinoma in situ of the breast: a review
- 1k Downloads
Ductal carcinoma in situ represents about 20% of all tumours diagnosed within mammographic screening programs. The natural history of DCIS is poorly understood, as it cannot be observed directly. Estimates of the proportion of DCIS that progress to invasive cancer, as well as factors that may influence progression, are important for clinical management. Here we review various sources of evidence regarding the natural history of DCIS.
We identified relevant publications of studies on: follow-up studies of DCIS initially misdiagnosed as benign, studies of recurrence of DCIS as invasive cancer, autopsy studies, studies of risk factors for DCIS, animal studies and studies that used mathematical models to study growth of DCIS and invasive cancer. Data sources included the MEDLINE data base, searches of articles cited in key reviews and editorials.
The most direct evidence regarding the progression of DCIS to invasive cancer comes from studies where DCIS was initially misdiagnosed as benign and treated by biopsy alone. These studies suggest that between 14–53% of DCIS may progress to invasive cancer over a period of 10 or more years. The reported prevalence of undiagnosed DCIS in autopsy studies, of approximately 9%, has been used to suggest a larger reservoir of DCIS may exist in the population. All types of study designs reviewed had limitations that may bias the estimate of progression in either direction.
The available evidence suggests not all DCIS will progress to invasive cancer in the medium term but precise estimates of progression are not possible given the limitations of the data. Mathematical modelling of various scenarios of progression and studies of genetic factors involved in progression may shed further light on the natural history of DCIS.
Keywordsbreast cancer DCIS models natural history progression
Unable to display preview. Download preview PDF.
Bircan Erbas is funded by NHMRC Public Health (Australia) Post-doctoral Research Fellowship. This research is supported by a DOD Concept Award No. DAMD 17-03-1-0687.
- 21.Buerger H, Mommers EC, Littmann R, Diallo R, Brinkschmidt C, Poremba C, Dockhorn-Dworniczak B, van Diest PJ, Bocker W, 2000 Correlation of morphologic and cytogenetic parameters of genetic instability with chromosomal alterations in in situ carcinomas of the breast Am J Clin Pathol 114: 854–859PubMedCrossRefGoogle Scholar
- 22.Fiche M, Avet-Loiseau H, Maugard CM, Sagan C, Heymann MF, Leblanc M, Classe JM, Fumoleau P, Dravet F, Mahe M, Dutrillaux B, 2000 Gene amplifications detected by fluorescence in situ hybridization in pure intraductal breast carcinomas: relation to morphology, cell proliferation and expression of breast cancer-related genes [In Process Citation] Int J Cancer 89: 403–410PubMedCrossRefGoogle Scholar
- 25.Poller DN, Silverstein MJ, Galea M, Locker AP, Elston CW, Blamey RW, Ellis IO, 1994 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 Mod Pathol 7: 257–262PubMedGoogle Scholar
- 26.Vos CB, ter Haar NT, Rosenberg C, Peterse JL, Cleton-Jansen AM, Cornelisse CJ, van de Vijver MJ, 1999 Genetic alterations on chromosome 16 and 17 are important features of ductal carcinoma in situ of the breast and are associated with histologic type Br J Cancer 81: 1410–1418PubMedCrossRefGoogle Scholar
- 32.Boecker W, Moll R, Dervan P, Buerger H, Poremba C, Diallo RI, Herbst H, Schmitt A, Lerch MM, Buchwalow IB, 2002 Usual ductal hyperplasia of the breast is a committed stem (progenitor) cell lesion distinct from atypical ductal hyperplasia and ductal carcinoma in situ J Pathol 198: 458–467PubMedCrossRefGoogle Scholar
- 33.Barnes DM, Bartkova J, Camplejohn RS, Gullick WJ, Smith PJ, Millis RR, 1992 Overexpression of the c-erbB-2 oncoprotein: why does this occur more frequently in ductal carcinoma in situ than in invasive mammary carcinoma and is this of prognostic significance? Eur J Cancer 28: 644–648PubMedCrossRefGoogle Scholar
- 36.Armes JE, Egan AJ, Southey MC, Dite GS, McCredie MR, Giles GG, Hopper JL, Venter DJ, 1998 The histologic phenotypes of breast carcinoma occurring before age 40 years in women with and without BRCA1 or BRCA2 germline mutations: a population-based study Cancer 83: 2335–2345PubMedCrossRefGoogle Scholar
- 37.Pathology of familial breast cancer: differences between breast cancers in carriers of BRCA1 or BRCA2 mutations, sporadic cases. Breast Cancer Linkage Consortium. Lancet 349: 1505–1510,1997Google Scholar
- 38.Hoogerbrugge N, Bult P, de Widt-Levert LM, Beex LV, Kiemeney LA, Ligtenberg MJ, Massuger LF, Boetes C, Manders P, Brunner HG, 2003 High prevalence of premalignant lesions in prophylactically removed breasts from women at hereditary risk for breast cancer J Clin Oncol 21: 41–45PubMedCrossRefGoogle Scholar
- 41.Ringberg A, Idvall I, Ferno M, Anderson H, Anagnostaki L, Boiesen P, Bondesson L, Holm E, Johansson S, Lindholm K, Ljungberg O, Ostberg G, 2000 Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast Eur J Surg Oncol 26: 444–451PubMedCrossRefGoogle Scholar
- 42.Bijker N, Peterse JL, Duchateau L, Julien JP, Fentiman IS, Duval C, Di Palma S, Simony-Lafontaine J, de Mascarel I, van de Vijver MJ, 2001 Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853 J Clin Oncol 19: 2263–2271PubMedGoogle Scholar
- 46.Kestin LL, Goldstein NS, Lacerna MD, Balasubramaniam M, Martinez AA, Rebner M, Pettinga J, Frazier RC, Vicini FA, 2000 Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy Cancer 88: 596–607PubMedCrossRefGoogle Scholar
- 50.Collins L, Tamimi R, Baer H, Connolly J, Colditz G, Schnitt S, 2004 Risk of invasive breast cancer in patients with ductal carcinoma in situ [DCIS] treated by diagnostic biopsy alone: results from the Nurses’ Health StudyBreast Cancer Res Treat Treat 88(sup1):1083Google Scholar
- 53.Lewis D, Geschickter CF, 1938 Comedo carcinoma of the breast Arch Surg 36: 225–234Google Scholar
- 62.Cutuli B, Cohen-Solal-le Nir C, de Lafontan B, Mignotte H, Fichet V, Fay R, Servent V, Giard S, Charra-Brunaud C, Lemanski C, Auvray H, Jacquot S, Charpentier JC, 2002 Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers’ experience Int J Radiat Oncol Biol Phys 53: 868–879PubMedGoogle Scholar
- 66.Erbas B, Amos A, Kavanagh A, Fletcher A, Gertig DM: Incidence of invasive breast cancer and ductal carcinoma in situ in a screening program by age: should older women continue screening? Cancer Epidemiol Biomarkers Prev Oct; 13(10): 1569–1573, 2004Google Scholar
- 84.Azzopardi JG, Ahmed A, Millis RR: Problems in breast pathology. Major Probl Pathol 11: i–xvi, 1–466, 1979Google Scholar