Original Article | Published:

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

Modern Pathology volume 28, pages 662669 (2015) | Download Citation

This work was presented in part as a platform presentation at the March 2010 USCAP meeting Abstract: Modern Pathology 2010;23(supp1):71A.

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 histological slides for 26 539 consecutive breast biopsies performed at Vanderbilt, Baptist and St Thomas Hospitals in Nashville, TN from 1950 to 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 1–7 years postdiagnosis 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 for older women.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , . Epithelial hyperplasia In: Elston CW, Ellis IO, (eds). The Breast 3rd edn. Churchill Livingstone: Edinburgh, UK, 1998, pp 65–89.

  2. 2.

    , , et al. Atypical hyperplastic lesions of the female breast. A long-term follow-up study. Cancer 1985;55:2698–2708.

  3. 3.

    , . A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer 1990;65:518–529.

  4. 4.

    , , et al. Continued local recurrence of carcinoma 15-25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer 1995;76:1197–1200.

  5. 5.

    , , et al. Intraductal carcinoma of the breast: follow-up after biopsy only. Cancer 1982;49:751–758.

  6. 6.

    , , et al. 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. Cancer 2005;103:2481–2484.

  7. 7.

    , , et al. Protocol for the examination of specimens from patients with ductal carcinoma in situ of the breast. Arch Pathol Lab Med 2009;133:15–25.

  8. 8.

    , . Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985;312:146–151.

  9. 9.

    , , et al. Benign breast disease and the risk of breast cancer. N Engl J Med 2005;353:229–237.

  10. 10.

    , , et al. Risk of breast cancer associated with atypical hyperplasia of lobular and ductal types. Cancer Epidemiol Biomarkers Prev 1997;6:297–301.

  11. 11.

    , , et al. Histopathologic types of benign breast lesions and the risk of breast cancer: case-control study. Am J Surg Pathol 2002;26:421–430.

  12. 12.

    , . Diagnostic Histopathology of the Breast. Churchill Livingstone: Edinburgh, London, UK; Melbourne, Australia; and New York, USA, 1987.

  13. 13.

    , . The Breast 3rd edn. Churchill Livingstone: Edinburgh, London, UK; New York, Philadelphia, SanFrancisco, USA; Sidney, Australia; Toronto, Canada, 1998.

  14. 14.

    . Special types of invasive breast cancer, with clinical implications. Am J Surg Pathol 2003;27:832–835.

  15. 15.

    . Statistical modeling for biomedical researchers: a simple introduction to the analysis of complex data 2nd edn. Cambridge University Press: Cambridge, UK, 2009.

  16. 16.

    , , et al. Intraductal carcinoma. Long-term follow-up after treatment by biopsy alone. JAMA 1978;239:1863–1867.

  17. 17.

    , , . The clinical significance of pre-invasive breast carcinoma. Cancer 1980;46:919–925.

  18. 18.

    , , et al. Risk of invasive breast cancer in patients with ductal carcinoma in situ [DCIS] treated by diagnostic biopsy alone:results from the Nurses' Health Study. Breast Cancer Res Treat 1994;88:1083.

  19. 19.

    , , et al. Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996;275:913–918.

  20. 20.

    , , et al. Increased diagnosis and detection rates of carcinoma in situ of the breast. Breast Cancer Res Treat 2012;133:779–784.

  21. 21.

    , , et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2009;27:5319–5324.

  22. 22.

    , , et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001;19:2263–2271.

  23. 23.

    , , et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer 1999;86:429–438.

  24. 24.

    , , et al. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989;63:618–624.

  25. 25.

    , , et al. Subclinical ductal carcinoma in situ of the breast. Treatment by local excision and surveillance alone. Cancer 1992;70:2468–2474.

  26. 26.

    , , et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:1455–1461.

  27. 27.

    , , et al. Noninvasive ductal carcinoma of the breast: the relevance of histologic categorization. Hum Pathol 1993;24:16–23.

  28. 28.

    , , et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 2006;24:3381–3387.

  29. 29.

    , , . Re: Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011;103:1723.

  30. 30.

    , , et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011;103:478–488.

  31. 31.

    , , et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010;2010:162–177.

  32. 32.

    , , et al. The consequence of undertreatment of patients treated with breast conserving therapy for ductal carcinoma in-situ. Am J Surg 2013;206:790–797.

  33. 33.

    , , et al. Invasive local recurrence increased after radiation therapy for ductal carcinoma in situ. Am J Surg 2008;196:552–555.

  34. 34.

    , . Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol 1992;23:1095–1097.

  35. 35.

    , , et al. Borderline atypical ductal hyperplasia/low-grade ductal carcinoma in situ on breast needle core biopsy should be managed conservatively. Am J Surg Pathol 2013;37:913–923.

  36. 36.

    , , et al. Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis. Curr Oncol 2014;21:e96–e104.

Download references

Acknowledgements

This work was supported by NCI Grants R01 CA050468, P50 CA098131 and P30 CA068485 and by an NCATS/NIH Grant UL1 TR000445.

Author information

Affiliations

  1. Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    • Melinda E Sanders
  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    • Peggy A Schuyler
    •  & William D Dupont
  3. Breast Pathology Consultants, Nashville, TN, USA

    • Jean F Simpson
  4. Department of Pathology, University of South Alabama, Mobile, AL, USA

    • Jean F Simpson
  5. 5905 Robert E Lee Court, Nashville, TN, USA

    • David L Page

Authors

  1. Search for Melinda E Sanders in:

  2. Search for Peggy A Schuyler in:

  3. Search for Jean F Simpson in:

  4. Search for David L Page in:

  5. Search for William D Dupont in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to Melinda E Sanders.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/modpathol.2014.141