336
Chapter 11
FIG. 11.2.
DCIS.
A:
Ductogram from an 84-year-old woman
with bloody nipple discharge. The cannulated lactiferous
duct is seen in the
lower left
. Numerous defects in the
white dye in ducts represent intraductal papillary lesions.
B:
Orderly papillary DCIS in the lumen and micropapillary
carcinoma at the periphery.
C:
Micropapillary DCIS.
Age at Diagnosis
DCIS occurs throughout the age range of breast carcinoma
in women. The mean age at diagnosis of patients in multiple
studies was between 50 and 59 years, quite similar to the
mean age of women with invasive duct carcinoma.
22,56,62,63
There are no significant differences in the age distributions
of structural subtypes of DCIS.
76
In 2012, in the United States, there is one diagnosis of
DCIS for every four diagnoses of invasive breast cancer. For
women 50 to 64 years of age, the incidence of DCIS has been
estimated to be 88 per 100,000. The risk of DCIS is minimal
in women less than 30 years of age and is low in women less
than 40 years of age. Thereafter, the risk increases steadily
between the ages 40 and 50, increases at a slower rate after
age 50, and plateaus after age 60.
15
A higher recurrence rate is associated with DCIS at a
younger age, generally regarded as under 40 years of age;
however, breast conservation therapy is possible in smaller,
lower grade, and nonnecrotic types of DCIS in which widely
negative margins have been achieved.
84
Women with DCIS
and a family history of ovarian carcinoma or those who had
a BRCAPRO (
BRCA
mutation carrier prediction model)
score of more than 10% had a 27% rate of
BRCA1/2
mutation
positivity regardless of age at diagnosis.
85
BRCAPRO is a sta-
tistically derived score for assessing the probability that an
individual carries a germline deleterious mutation of
BRCA1
and
BRCA2
genes, based on family history.
Bilaterality
Limited data are available describing the frequency of
bilaterality associated with DCIS in one breast.
86,87
Among
112 patients withDCIS reported by Ashikari et al.,
72
16 (14%)
had concurrent contralateral carcinoma, and 17 (15%)
had undergone mastectomy previously for carcinoma.
Westbrook and Gallager
73
excluded an unstated number of
patients with previous or concurrent contralateral invasive
carcinoma from their study of DCIS. Subsequent contralat-
eral biopsies obtained from 14 of the 64 women included
in the report revealed DCIS in five and invasion in three
others, for an overall frequency of subsequent carcinoma in
the opposite breast of 12.5%. The average length of follow-
up was not stated. Brown et al.
88
found that 10% of patients
with DCIS in one breast had contralateral invasive carci-
noma, including three women treated previously for the
contralateral lesion and one who subsequently developed
contralateral carcinoma. No information about concurrent
