The natural history of low‐grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long‐term follow‐up

• Published in: Cancer Vol. 103; no. 12; pp. 2481 - 2484
• Main Authors: Sanders, Melinda E., Schuyler, Peggy A., Dupont, William D., Page, David L.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-06-2005; Wiley-Liss
• Subjects: Adult; Biological and medical sciences; Biopsy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Cohort Studies; ductal carcinoma in situ; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; long‐term follow‐up; low‐grade; Mammary gland diseases; Medical sciences; natural history; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Prognosis; Prospective Studies; Tumors; Human; Ductal carcinoma; Carcinoma in situ; Malignant tumor; Long term; natural history; long-term follow- up; low-grade; ductal carcinoma in situ; Mammary gland diseases; Breast carcinoma; Cancerology; Treatment; Biopsy; Adult; Female; Mammary gland; Low grade
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21069

BACKGROUND
Opportunities to study the natural history of ductal carcinoma in situ (DCIS) are rare. A few studies of incompletely excised lesions in the premammographic era now recognized as DCIS have provided critical insights into its proclivity for local recurrence in the original site. At the time the biopsies in the current study were originally examined, small DCIS was not diagnosed and, by default, these women were treated by biopsy only.
METHODS
The authors report the latest results from a follow‐up study, which was published originally in 1982, of 28 women with low‐grade DCIS who were treated by biopsy only. These women were from a large, prospectively identified, completely characterized cohort.
RESULTS
Eleven of 28 women developed invasive breast carcinoma (IBC), all in the same breast and quadrant from which their low‐grade DCIS biopsy was taken. Seven IBCs were diagnosed within 10 years of the DCIS biopsy, 1 was diagnosed within 12 years of the DCIS biopsy, and the remaining 3 IBCs were diagnosed over 23–42 years. Five of these women, including 1 woman who developed IBC 29 years after her DCIS biopsy, developed distant metastasis, which resulted in death 1–7 years after the diagnosis of IBC.
CONCLUSIONS
The natural history of low‐grade DCIS can extend greater than 4 decades, with IBC developing at the same site as the previous DCIS in the majority of women. This natural history differs markedly from that of patients with high‐grade DCIS and from the outcome of patients with any completely delimited DCIS excised to negative margins. Cancer 2005. © 2005 American Cancer Society.
Small, low‐grade, noncomedo ductal carcinoma in situ is the pivotal lesion in understanding the borderline between malignancy and nonmalignancy in the female breast. Noncomedo ductal carcinoma in situ is a nonobligate precursor that involves a very long clinical evolution to invasive carcinoma in approximately 50% of patients when excised incompletely.