Clinical Review

Ductal carcinoma in situ of the breast

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e797 (Published 29 February 2012) Cite this as: BMJ 2012;344:e797

This article has a correction. Please see:

  1. Nicola L P Barnes, specialist registrar breast surgery1,
  2. Jane L Ooi, consultant breast and oncoplastic surgeon1,
  3. John R Yarnold, professor of clinical oncology2,
  4. Nigel J Bundred, professor of surgical oncology3
  1. 1Breast Unit, Royal Bolton Hospital, Bolton BL4 0JR, UK
  2. 2Radiotherapy Unit, Institute of Cancer Research and Royal Marsden Hospital, London, UK
  3. 3Department of Surgical Oncology, South Manchester University Hospital, Manchester, UK
  1. Correspondence to: N L P Barnes nicolabarnes{at}doctors.org.uk
  • Accepted 16 January 2012

Summary points

  • Ductal carcinoma in situ (DCIS) is a preinvasive breast cancer—malignant cells are confined within an intact ductal basement membrane

  • Most cases (90%) are asymptomatic and detected at screening, but it can present as Paget’s disease of the nipple, nipple discharge, or a lump

  • Treatment aims to prevent invasive disease

  • Oestrogen receptor status tends to be preserved in recurrences or disease progression; this has implications for adjuvant treatment and reducing risk of recurrence

  • The optimum treatment is unclear, and urgent clarification is needed

  • Women with DCIS should have the option of entering high quality randomised controlled trials

Ductal carcinoma in situ (DCIS) is a preinvasive (also termed non-invasive) breast cancer, where proliferations of malignant ductal epithelial cells remain confined within intact breast ducts (fig 1). DCIS is a precursor lesion that has the potential to transform into an invasive cancer over a timescale that may be a few years or decades long. The development of its ability to invade and metastasise is as yet unquantifiable and is attributed to the accumulation of somatic mutations in premalignant cells. Treatment aims to prevent DCIS from progressing to invasive breast cancer.

Fig 1 Difference between normal, ductal carcinoma in situ (DCIS), and invasive disease

DCIS was rarely diagnosed before the introduction of national screening programmes but is now common, accounting for 20% of screen detected cancers in the United Kingdom.1 Treatment usually comprises surgery (mastectomy or wide local excision), with or without adjuvant radiotherapy. However, it is possible that a subset of these lesions would never progress to invasive breast cancer over the lifetime of the patient if left untreated, and in this (as yet undefined) population traditional management may represent overtreatment. Deciding on appropriate personalised treatment for individual patients diagnosed with DCIS is an ongoing challenge, because the optimum management remains …

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