Breast Cancer Research and Treatment

, Volume 152, Issue 2, pp 293–304 | Cite as

Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients

  • Valerie Cui Yun Koh
  • Jeffrey Chun Tatt Lim
  • Aye Aye Thike
  • Poh Yian Cheok
  • Minn Minn Myint Thu
  • Veronique Kiak Mien Tan
  • Benita Kiat Tee Tan
  • Kong Wee Ong
  • Gay Hui Ho
  • Wai Jin Tan
  • Yongcheng Tan
  • Ahmed Syed Salahuddin
  • Inny Busmanis
  • Angela Pek Yoon Chong
  • Jabed Iqbal
  • Shyamala Thilagaratnam
  • Jill Su Lin Wong
  • Puay Hoon TanEmail author
Preclinical study


Breast cancer is the most common malignancy in Singapore women. Ductal carcinoma in situ (DCIS) is the putative, non-obligate precursor of the majority of invasive breast cancers. The efficacy of the Singapore breast-screening pilot project in detecting early stage breast cancer led to the launch of a national breast-screening programme, BreastScreen Singapore (BSS), in January 2002. In this study, we compared clinicopathological and immunohistochemical characteristics, as well as clinical outcomes, between screen-detected and symptomatic DCIS. The study cohort comprised 1202 cases of DCIS diagnosed at Singapore General Hospital from 1994 to 2010. Comparison of clinicopathological parameters, immunohistochemical results of ER, PR, HER2, CK14, EGFR, and 34βE12, and clinical outcomes was carried out between the 2 groups. Amongst 1202 cases, 610 (50.7 %) were screen-detected and 592 (49.3 %) were symptomatic DCIS. Screen-detected cases were smaller in size (P < 0.001), of lower nuclear grade (P = 0.004), and more frequently expressed ER (P < 0.001). Luminal A phenotype was more frequently observed in screen-detected DCIS, while triple-negative and HER2 phenotypes were more common in symptomatic DCIS (P < 0.001). The basal-like phenotype was also more frequent in symptomatic DCIS (P = 0.041). Mean and median follow-up was 99.7 and 97.8 months, respectively, with a maximum follow-up of 246.0 months. More symptomatic patients developed invasive recurrences compared to screen-detected patients (P = 0.001). A trend for better disease-free survival was observed in screen-detected patients (P = 0.076). Patients who were screen-detected experienced better overall survival than those with symptomatic DCIS (P = 0.007). Our data indicate a more favourable outcome of screen-detected DCIS patients confirming the role of BSS in early identification of this curable disease.


DCIS Screen detected Symptomatic Immunohistochemistry Clinicopathological parameters Recurrence Survival 



This study was supported by the Health Services Research Competitive Research Grant, HSRG/0009/2010, from the Ministry of Health, Singapore.

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Valerie Cui Yun Koh
    • 1
  • Jeffrey Chun Tatt Lim
    • 1
  • Aye Aye Thike
    • 1
  • Poh Yian Cheok
    • 1
  • Minn Minn Myint Thu
    • 1
  • Veronique Kiak Mien Tan
    • 2
  • Benita Kiat Tee Tan
    • 3
  • Kong Wee Ong
    • 2
  • Gay Hui Ho
    • 2
  • Wai Jin Tan
    • 1
  • Yongcheng Tan
    • 1
  • Ahmed Syed Salahuddin
    • 1
  • Inny Busmanis
    • 1
  • Angela Pek Yoon Chong
    • 1
  • Jabed Iqbal
    • 1
  • Shyamala Thilagaratnam
    • 4
    • 5
  • Jill Su Lin Wong
    • 6
  • Puay Hoon Tan
    • 1
    • 7
    • 8
    Email author
  1. 1.Department of PathologySingapore General HospitalSingaporeSingapore
  2. 2.Division of Surgical OncologyNational Cancer Centre SingaporeSingaporeSingapore
  3. 3.Department of General SurgerySingapore General HospitalSingaporeSingapore
  4. 4.Regional Health & Community Outreach DivisionHealth Promotion Board, SingaporeSingaporeSingapore
  5. 5.Saw Swee Hock School of Public Health, Tahir Foundation BuildingNational University of SingaporeSingaporeSingapore
  6. 6.Division of Oncologic ImagingNational Cancer Centre SingaporeSingaporeSingapore
  7. 7.Department of AnatomyYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
  8. 8.Duke-NUS Graduate Medical School SingaporeSingaporeSingapore

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