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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. 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

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