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Practice ABC of Breast Diseases, 4th Edition

Carcinoma in situ

BMJ 2013; 347 doi: (Published 23 December 2013) Cite this as: BMJ 2013;347:bmj.f3289
  1. Nigel Bundred1,
  2. J Michael Dixon2
  1. 1University Hospital of South ManchesterAcademic Department of Surgery Manchester, UK
  2. 2Western General HospitalEdinburgh Breast Unit Edinburgh, UK

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  • The number of women with carcinoma in situ continues to increase and comprises approximately 25% of all ‘malignancy’ detected through screening

  • Localised DCIS can be treated by breast-conserving surgery with or without radiotherapy

  • The role of hormone therapy in preventing recurrence of DCIS after breast-conserving surgery continues to be investigated

  • For patients with larger areas of DCIS, mastectomy with or without breast reconstruction is effective

  • Factors that influence local recurrence in DCIS after breast-conserving surgery include completeness of excision, radiotherapy, patient age and histological grade

Carcinoma in situ

Two main types of non-invasive (in situ) cancer can be recognised from the histological pattern of disease and cell type (Table 1). Ductal carcinoma in situ is the most common form of non-invasive carcinoma, making up 3–4% of symptomatic and 20–25% of screen-detected cancers. It has increased in frequency because of the widespread use of screening mammography (Figure 1). The increase is across all age groups, with a 12% annual increase in the 30–39-year age group and an 18.1% annual increase in women over the age of 50. Ductal carcinoma in situ is characterised by distortion, distention and complete involvement by a similar and neoplastic population of cells of adjacent ducts and lobular units (Figure 2). By contrast, lobular carcinoma in situ, now known as lobular intraepithelial neoplasia (LIN), which incorporates what was previously known as lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH), is rare (<1% of screen-detected cancers) and presents as relatively uniform expansion of the whole lobule by regular cells …

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