Continued observation of the natural history of low-grade ductal carcinoma in situ reaffirms proclivity for local recurrence even after more than 30 years of follow-up

Abstract

Opportunities to study the natural history of ductal carcinoma in situ are rare. A few studies of incompletely excised lesions in the premammographic era, retrospectively recognized as ductal carcinoma in situ, have demonstrated a proclivity for local recurrence in the original site. The authors report a follow-up study of 45 women with low grade ductal carcinoma in situ treated by biopsy only, recognized retrospectively during a larger review of surgical pathology diagnoses and original histologic slides for 26,539 consecutive breast biopsies performed at Vanderbilt, Baptist, and St. Thomas Hospitals in Nashville, TN from 1950–1989. Long-term follow-up was previously reported on 28 of these women. Sixteen women (36%) developed invasive breast carcinoma, all in the same breast and quadrant as their incident ductal carcinoma in situ. Eleven invasive breast carcinomas were diagnosed within 10 years of the ductal carcinoma in situ biopsy. Subsequent cases were diagnosed at 12, 23, 25, 29 and 42 years. Seven women, including one who developed invasive breast cancer 29 years after her ductal carcinoma in situ biopsy, developed distant metastasis, resulting in death 1 to 7 years post diagnosis of invasive breast carcinoma. The natural history of low-grade ductal carcinoma in situ may extend more than four decades, with invasive breast cancer developing at the same site as the index lesion. This protracted natural history differs markedly from that of patients with high grade ductal carcinoma in situ or any completely delimited ductal carcinoma in situ excised to negative margins. This study reaffirms the importance of complete margin evaluation in women treated with breast conservation for ductal carcinoma in situ as well as balancing recurrence risk with possible treatment-related morbidity forolder women.

Behaviour and characteristics of low‐grade ductal carcinoma in situ of the breast: literature review and single‐centre retrospective series

“…This indicates a substantial tendency for low-grade DCIS to recur locally when there is inadequate excision. In addition, as mentioned above, although the natural history of DCIS is not well understood due to surgical intervention, studies [13][14][15][16][17] investigating the outcome of women diagnosed with DCIS treated only with biopsy have shown that low-grade DCIS, when left untreated, has a propensity for local invasive recurrence even after long follow-up periods of more than 40 years, and that it is important not to overlook them. Details of the ipsilateral recurrences in our study cohort in Table 5 showed a number of intermediateand high-grade DCIS and IDC.…”

Developing in vitro models of human ductal carcinoma in situ from primary tissue explants

“…Natural history studies suggest that some patients do not develop invasive breast cancer without treatment, even after long follow-up [1][2][3][4][5]. Although current clinicopathologic features and risk models stratify DCIS patients into different risk groups, the currently available clinical tools are imperfect [6][7][8], and in an individual case, it is difficult to predict the risk of invasive disease.…”

A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

“…30 Sixteen of these low-grade DCIS patients developed invasive carcinoma in the same breast quadrant within three to 42 years after initial biopsy. 30 More recently, Maxwell et al reported a series of 89 DCIS patients who either declined or were unfit to undergo surgery. 31 One in three patients developed invasive carcinoma after a median interval of 45 months, and high-grade DCIS patients showed a significantly higher risk for developing invasive carcinoma (48%) than intermediate or lowgrade DCIS patients (32 and 18%, respectively).…”

“…reported on a cohort of 45 patients with low‐grade DCIS, initially diagnosed as having benign breast disease and therefore “treated” with biopsy only . Sixteen of these low‐grade DCIS patients developed invasive carcinoma in the same breast quadrant within three to 42 years after initial biopsy . More recently, Maxwell et al .…”