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

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Abstract

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.

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Acknowledgments

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

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Diagnostics Tower, Singapore, 169856, Singapore

    Valerie Cui Yun Koh, Jeffrey Chun Tatt Lim, Aye Aye Thike, Poh Yian Cheok, Minn Minn Myint Thu, Wai Jin Tan, Yongcheng Tan, Ahmed Syed Salahuddin, Inny Busmanis, Angela Pek Yoon Chong, Jabed Iqbal & Puay Hoon Tan

  2. Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    Veronique Kiak Mien Tan, Kong Wee Ong & Gay Hui Ho

  3. Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Benita Kiat Tee Tan

  4. Regional Health & Community Outreach Division, Health Promotion Board, Singapore, 3 Second Hospital Avenue, Singapore, 168937, Singapore

    Shyamala Thilagaratnam

  5. Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore

    Shyamala Thilagaratnam

  6. Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    Jill Su Lin Wong

  7. Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive, MD6, #14-02T, Singapore, 117599, Singapore

    Puay Hoon Tan

  8. Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore, 169857, Singapore

    Puay Hoon Tan

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  1. Valerie Cui Yun Koh
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  2. Jeffrey Chun Tatt Lim
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Koh, V.C.Y., Lim, J.C.T., Thike, A.A. et al. Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients. Breast Cancer Res Treat 152, 293–304 (2015). https://doi.org/10.1007/s10549-015-3472-6

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