Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study

Abstract

In a Danish nationwide prospective study of in situ carcinoma of the breast, a total of 275 women, treated with excision alone, were registered from 1982 to 1989. The series included 142 cases of ductal carcinoma in situ (DCIS), 100 cases of lobular carcinoma in situ (LCIS), 26 cases of DCIS+LCIS, and seven cases of atypical hyperplasia (AH). Within a median follow-up of 120 months, a crude recurrence rate of 28% (76 cases) was found, of which 53% (40 cases) recurred as invasive carcinomas (IC) and 47% (36 cases) as CIS. CIS recurrences appeared after median 18 months, compared to median 42 months for IC recurrences. No statistical difference was found with respect to development of IC between the three groups of DCIS, DCIS+LCIS, and LCIS. The majority of recurrences were ipsilateral, also for LCIS. Forty four of 49 recurrences following DCIS, and seven of nine recurrences following DCIS+LCIS occurred as local recurrences. Histopathologically, in DCIS a strong association was found between large nuclear size and comedonecrosis. Univariate analysis showed a significant association to recurrence for nuclear size, comedonecrosis, and size of the original lesion. Multivariate analysis showed that only comedonecrosis and size of lesion were independent predictors of recurrence, however, specimen margins were not included in the analysis, as this parameter could not be adequately evaluated in the present series. Nuclear size of original DCIS lesion was related to histologic grade of the IC recurrence. The recurrence rate for DCIS of small nuclear size increased from 6% at five years of follow-up to 16% at 10 years, possibly due to a slower growth rate and a continued but delayed risk. Similarities were found between LCIS and DCIS of small nuclear size, both showing a continued risk and comparable rate of recurrence. Further, progression to IC of similar, highly differentiated type was seen, indicating a linkage between biological behavior of the two histological types.

Risk of subsequent invasive breast carcinoma after in situ breast carcinoma in a population covered by national mammographic screening

“…All in situ breast carcinomas are premalignant, being possible precursors to invasive disease capable of metastasis Page et al, 1985Page et al, , 2000Page and Dupont, 1990;London et al, 1992). The potential for progression to invasive cancer has been measured in earlier studies (Franceschi et al, 1998;Ottesen et al, 2000;Crocetti et al, 2001;Warnberg et al, 2001). However, the number of cases analysed previously was small.…”

“…Our data agree with earlier results, that the highest risk of invasive cancer is reached after 42 to 60 months after diagnosis of in situ lesions. (Franceschi et al, 1998;Ottesen et al, 2000;Warnberg et al, 2000Warnberg et al, , 2001Crocetti et al, 2001).…”

Progesterone Receptor A and B Isoforms in the Human Breast and Its Disorders

“…These specimens included 47 cases of invasive ductal carcinoma (IDC), 40 cases of ductal carcinoma in situ (DCIS), 27 cases of atypical ductal hyperplasia (ADH), and 27 cases of proliferative disease without atypia (PDWA) including moderate and florid hyperplasia of the usual type. Pathological diagnosis was based on the work of Dupont et al 5) and of Ottesen et al 6) Classification of DCIS was based on the Consensus Conference on the Classification of Ductal Carcinoma In Situ in 1997. 7) Non-pathological breast tissues were available for examination in 13, 12 and 12 cases of DCIS, ADH and PDWA, respectively.…”

Impact of concurrent proliferative high‐risk lesions on the risk of ipsilateral breast carcinoma recurrence and contralateral breast carcinoma development in patients with ductal carcinoma in situ treated with breast‐conserving therapy

“…One study, which included 26 patients with concurrent DCIS and LCIS, showed an overall recurrence rate of 35% in both patients with DCIS and those with DCIS and LCIS treated with surgery alone. 4 Provenzano et al 5 showed that the presence of concurrent ADH in 13 patients with DCIS did not significantly affect ipsilateral breast recurrence rates. Those investigators did not examine the effects of concurrent ADH and DCIS on the development of CBC.…”

“…However, compared with mastectomy breast-conserving sur-gery with radiation therapy is associated with a higher rate of local recurrence, with approximately half of all recurrences being invasive. 3 While several investigators have examined the effect of various tumor factors on ipsilateral breast carcinoma recurrence (IBCR) in patients with DCIS, few 4,5 have examined the effect of the presence of other lesions in the surrounding breast tissue on the rate of IBCR in patients with DCIS. To our knowledge, no studies have examined the effect of the presence of other lesions on the rate of development of contralateral breast carcinoma (CBC) in patients with DCIS.…”