Materiały źródłowe

• #1 Breast Ductal Carcinoma in Situ – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567766/

  Ductal carcinoma in situ (DCIS) of the breast represents neoplastic lesions, typically localized to the breast ducts with no evidence of invasion into the surrounding tissue. […] Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is a non-invasive breast cancer characterized by a proliferation of abnormal epithelial cells confined within the basement membrane. Disruption of the basement membrane layer would change the diagnosis from DCIS to invasive breast cancer. DCIS is considered to be a precursor for invasive breast cancer. […] The evolution of normal breast tissue to DCIS is unknown. There is a genetic predisposition in some but not all patients with DCIS, most notably BRCA1 and BRCA2 mutations. […] Rates of diagnosis have been increasing with the use of screening mammography that detects pre-clinical microcalcifications. However, the diagnosis of DCIS does require a tissue biopsy. The treatment for DCIS is multidisciplinary and may include surgery, hormone therapy, and radiation therapy.

• #2 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Ductal carcinoma in situ (DCIS) is a neoplastic proliferation of mammary ductal epithelial cells confined to the ductal-lobular system without evidence of invasion through the basement membrane into the surrounding stroma (Arch Pathol Lab Med 2009;133:15) […] Is a nonobligate precursor lesion of invasive breast cancer (Breast Cancer Res Treat 2010;123:757, Cancer 2005;103:2481) […] Encompasses a heterogeneous group of lesions in terms of histomorphology, underlying genetic alterations, biomarker expression profile and biologic potential for progression to invasive carcinoma […] Neoplastic proliferation of mammary ductal epithelial cells that is confined within ducts and lobules […] Nonobligate precursor of invasive breast disease […] Heterogenous entity with wide range of histologic appearances, growth patterns, genetic abnormalities and clinical behavior

• #3 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Ductal carcinoma in situ (DCIS) is a neoplastic proliferation of mammary ductal epithelial cells confined to the ductal-lobular system without evidence of invasion through the basement membrane into the surrounding stroma (Arch Pathol Lab Med 2009;133:15) […] Is a nonobligate precursor lesion of invasive breast cancer (Breast Cancer Res Treat 2010;123:757, Cancer 2005;103:2481) […] Encompasses a heterogeneous group of lesions in terms of histomorphology, underlying genetic alterations, biomarker expression profile and biologic potential for progression to invasive carcinoma […] Neoplastic proliferation of mammary ductal epithelial cells that is confined within ducts and lobules […] Nonobligate precursor of invasive breast disease […] Heterogenous entity with wide range of histologic appearances, growth patterns, genetic abnormalities and clinical behavior

• #4 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Ductal carcinoma in situ (DCIS) represents pre-invasive breast carcinoma. In untreated cases, 2560% DCIS progress to invasive ductal carcinoma (IDC). […] A deeper understanding of the biological nature of DCIS and the molecular journey of the DCIS-IDC transition is crucial for more effective clinical management. Here, we reviewed the key signaling pathways in breast cancer that may contribute to DCIS initiation and progression. […] DCIS is often categorized as non-invasive or pre-invasive stage of breast cancer. Nonetheless, our understanding of the underlying causes of DCIS as well as how it progressed to be invasive is limited. […] The histologic characteristic that primarily distinguishes between DCIS and IDC is that DCIS tumor cells remain confined to the mammary ductal-lobular system without invading the surrounding parenchyma and the myoepithelial layer and basement membrane are intact, while IDC tumor cells have escaped the myoepithelial layer and spread into surrounding tissues.

• #5 Ductal carcinoma in situ (DCIS) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dcis/symptoms-causes/syc-20371889

  Ductal carcinoma in situ is a very early form of breast cancer. In ductal carcinoma in situ, the cancer cells are confined inside a milk duct in the breast. The cancer cells haven’t spread into the breast tissue. […] This early form of breast cancer happens when cells inside a breast duct develop changes in their DNA. A cell’s DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. […] In DCIS, the cancer cells don’t yet have the ability to break out of the breast duct and spread into the breast tissue. […] Healthcare professionals don’t know exactly what causes the changes in the cells that leads to DCIS. Factors that may play a part include lifestyle, environment and DNA changes that run in families.

• #6 Ductal Carcinoma In Situ of the Breast

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4484537/

  Ductal carcinoma in situ (DCIS) of the breast is a potentially invasive neoplasm. Risk factors include high estrogen states such as use of oral contraceptive (OC) pills, nulliparity, advanced age at first birth, and also family history and genetic mutations. […] Advances in molecular biology and pathology have led to a better understanding on the evolution from ductal carcinoma in situ to invasive cancer. […] Various factors have been implicated in the development of the condition. Chromosomal imbalances including loss of heterozygosity occur in more than 70 % of high-grade carcinomas. […] Molecular markers, such as expression of the estrogen receptor, overexpression of the human epidermal growth factor receptor 2 (HER2)/neu proto-oncogene and mutation in the p53 tumor suppressor gene have been identified. The expression of these markers is similar to that in invasive cancer. Hence, the factors causing DCIS are those implicated in invasive cancer as well.

• #7 Ductal Carcinoma In Situ of the Breast

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4484537/

  Ductal carcinoma in situ (DCIS) of the breast is a potentially invasive neoplasm. Risk factors include high estrogen states such as use of oral contraceptive (OC) pills, nulliparity, advanced age at first birth, and also family history and genetic mutations. […] Advances in molecular biology and pathology have led to a better understanding on the evolution from ductal carcinoma in situ to invasive cancer. […] Various factors have been implicated in the development of the condition. Chromosomal imbalances including loss of heterozygosity occur in more than 70 % of high-grade carcinomas. […] Molecular markers, such as expression of the estrogen receptor, overexpression of the human epidermal growth factor receptor 2 (HER2)/neu proto-oncogene and mutation in the p53 tumor suppressor gene have been identified. The expression of these markers is similar to that in invasive cancer. Hence, the factors causing DCIS are those implicated in invasive cancer as well.

• #8 Ductal Carcinoma In Situ of the Breast

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4484537/

  Ductal carcinoma in situ (DCIS) of the breast is a potentially invasive neoplasm. Risk factors include high estrogen states such as use of oral contraceptive (OC) pills, nulliparity, advanced age at first birth, and also family history and genetic mutations. […] Advances in molecular biology and pathology have led to a better understanding on the evolution from ductal carcinoma in situ to invasive cancer. […] Various factors have been implicated in the development of the condition. Chromosomal imbalances including loss of heterozygosity occur in more than 70 % of high-grade carcinomas. […] Molecular markers, such as expression of the estrogen receptor, overexpression of the human epidermal growth factor receptor 2 (HER2)/neu proto-oncogene and mutation in the p53 tumor suppressor gene have been identified. The expression of these markers is similar to that in invasive cancer. Hence, the factors causing DCIS are those implicated in invasive cancer as well.

• #9 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Women diagnosed with DCIS have 10 times higher risk of developing ipsilateral invasive breast if untreated (N Engl J Med 2004;350:1430, Cancer 1982;49:751) […] 36 – 53% of low grade DCIS lesions progress to invasive lesions if untreated (Mod Pathol 2015;28:662, Cancer 1980;46:919) […] Risk of progression of untreated high grade DCIS to invasive carcinoma is not well characterized as most clinically detected high grade DCIS is excised surgically (N Engl J Med 2004;350:1430) […] Long term outcome meta analysis study of DCIS showed a 15 year total local recurrence rate of 40% with 28% recurring as invasive disease (BMC Cancer 2015;15:890) […] Positive surgical margins, high nuclear grade, large lesion size, comedo necrosis and young age (< 45 years) reported as the most important clinical pathologic predictors associated with local recurrence and prognosis (J Clin Oncol 1996;14:754, Int J Radiat Oncol Biol Phys 2001;50:991, Cancer 1999;85:616, J Clin Oncol 2006;24:3381, Cancer 2005;103:2481, Breast Cancer Res Treat 2008;109:405, Eur J Cancer 2007;43:291, Breast J 2005;11:242) [...] Low grade DCIS and high grade DCIS are genetically distinct [...] High grade DCIS has similar molecular profile as invasive breast cancer (Cancer Res 2015;75:3980).

• #10 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Similar epidemiologic risk factors to invasive breast cancer, including older age, family history of breast cancer, nulliparity, late age at first birth, late menopause, elevated body mass index, high mammographic breast density, postmenopausal hormonal therapy use and genetic risk factors (e.g. BRCA1/2) (Mol Oncol 2010;4:357, Clinics (Sao Paulo) 2013;68:674, J Transl Med 2015;13:335) […] Represents 20 – 25% of newly diagnosed breast cancers in the United States (CA Cancer J Clin 2017;67:7, Am Surg 2018;84:1) […] 3.3 – 5.9% of women with DCIS carry a germline mutation in BRCA1 or BRCA2 and prevalence of BRCA mutation is significantly greater in women diagnosed with DCIS before the age 50 and personal or family history of breast cancer (JAMA 2005;293:964, Cancer Prev Res (Phila) 2010;3:1579, J Clin Oncol 2002;20:1480)

• #11 Ductal Carcinoma In Situ of the Breast

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4484537/

  Ductal carcinoma in situ (DCIS) of the breast is a potentially invasive neoplasm. Risk factors include high estrogen states such as use of oral contraceptive (OC) pills, nulliparity, advanced age at first birth, and also family history and genetic mutations. […] Advances in molecular biology and pathology have led to a better understanding on the evolution from ductal carcinoma in situ to invasive cancer. […] Various factors have been implicated in the development of the condition. Chromosomal imbalances including loss of heterozygosity occur in more than 70 % of high-grade carcinomas. […] Molecular markers, such as expression of the estrogen receptor, overexpression of the human epidermal growth factor receptor 2 (HER2)/neu proto-oncogene and mutation in the p53 tumor suppressor gene have been identified. The expression of these markers is similar to that in invasive cancer. Hence, the factors causing DCIS are those implicated in invasive cancer as well.

• #12 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Ductal carcinoma in situ (DCIS) represents pre-invasive breast carcinoma. In untreated cases, 2560% DCIS progress to invasive ductal carcinoma (IDC). […] A deeper understanding of the biological nature of DCIS and the molecular journey of the DCIS-IDC transition is crucial for more effective clinical management. Here, we reviewed the key signaling pathways in breast cancer that may contribute to DCIS initiation and progression. […] DCIS is often categorized as non-invasive or pre-invasive stage of breast cancer. Nonetheless, our understanding of the underlying causes of DCIS as well as how it progressed to be invasive is limited. […] The histologic characteristic that primarily distinguishes between DCIS and IDC is that DCIS tumor cells remain confined to the mammary ductal-lobular system without invading the surrounding parenchyma and the myoepithelial layer and basement membrane are intact, while IDC tumor cells have escaped the myoepithelial layer and spread into surrounding tissues.

• #13 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent lineage model hypothesizes that DCIS and IDC derive from two distinct normal epithelial cells. […] The evolutionary bottleneck model for DCIS-IDC transition hypothesizes that during the transition, only a small proportion of DCIS tumor cells with specific genetic events are selected to form a single clone, which subsequently breaks the evolutionary bottleneck and evolves into IDC. […] The multiclonal invasion model differs from the evolutionary bottleneck model in that it refers to multiple subclones escaping and co-migrating to invasive regions to generate IDC. […] The convergent phenotype model describes that subclones of different genotypes within DCIS may all give rise to an invasive phenotype to establish IDC, with concordant genomic profiles between the DCIS and related IDC.

• #14 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent lineage model hypothesizes that DCIS and IDC derive from two distinct normal epithelial cells. […] The evolutionary bottleneck model for DCIS-IDC transition hypothesizes that during the transition, only a small proportion of DCIS tumor cells with specific genetic events are selected to form a single clone, which subsequently breaks the evolutionary bottleneck and evolves into IDC. […] The multiclonal invasion model differs from the evolutionary bottleneck model in that it refers to multiple subclones escaping and co-migrating to invasive regions to generate IDC. […] The convergent phenotype model describes that subclones of different genotypes within DCIS may all give rise to an invasive phenotype to establish IDC, with concordant genomic profiles between the DCIS and related IDC.

• #15 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #16 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #17 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #18 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  The interplay between cancer cells and immune cells plays a pivotal role in cancer development and progression. […] Understanding these critical immune alterations that occur during the progression of preinvasive DCIS to invasive breast cancer will help differentiate high-risk DCIS from those with a low risk of progression. […] A key feature of DCIS progression is the loss of the surrounding ductal epithelium, which limits the exposure of ductal cancer cells to surrounding immune cells. […] Disruption of the myoepithelial layer, that forms a physical barrier, is a hallmark of progression of DCIS to invasive breast carcinoma. […] The impact of these epigenetic factors becomes clearer with a subsequent increase in breast cancer rate of Asian women living in Western countries. […] Numerous studies provide evidence that DNA methylation of gene promoters is an early event, and a majority of DNA methylation changes have already occurred prior to invasive breast carcinoma.

• #19

  https://link.springer.com/article/10.1007/s10911-022-09517-7

  The DCIS to IDC transition is characterized phenotypically by the fragmentation of the myoepithelium and the basement membrane. […] Loss of these physical barriers allows tumor cell invasion into the microenvironment and lymphovascular space. […] Myoepithelial cells surrounding DCIS lesions adjacent to invasive breast cancer show increased expression of proteins that promote ECM remodeling and decreased expression of proteins that inhibit ECM remodeling, compared to myoepithelial cells surrounding pure DCIS lesions that do not have adjacent invasive disease. […] Changes to the tumor cells and other neighboring cell types during the invasive transition may hold prognostic potential for predicting whether future DCIS patients are at high or low risk of invasive progression.

• #20

  https://link.springer.com/article/10.1007/s10911-022-09517-7

  Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive ductal carcinoma (IDC), whereby if left untreated, approximately 12% of patients develop invasive disease. […] Recent evidence suggests that a spectrum of cell types within the DCIS microenvironment are genetically and phenotypically altered compared to normal tissue and play critical roles in disease progression. […] Uncovering the molecular mechanisms contributing to DCIS progression has provided optimism for the search for well-validated prognostic biomarkers that can accurately predict the risk for a patient developing IDC. […] The discovery of such markers would modernize DCIS management and allow tailored treatment plans. […] The transition to invasive disease might not be regulated entirely at the genomic level but instead may be influenced by cellular relationships and interactions within and between DCIS and its microenvironment.

• #21

  https://link.springer.com/article/10.1007/s10911-022-09517-7

  The DCIS to IDC transition is characterized phenotypically by the fragmentation of the myoepithelium and the basement membrane. […] Loss of these physical barriers allows tumor cell invasion into the microenvironment and lymphovascular space. […] Myoepithelial cells surrounding DCIS lesions adjacent to invasive breast cancer show increased expression of proteins that promote ECM remodeling and decreased expression of proteins that inhibit ECM remodeling, compared to myoepithelial cells surrounding pure DCIS lesions that do not have adjacent invasive disease. […] Changes to the tumor cells and other neighboring cell types during the invasive transition may hold prognostic potential for predicting whether future DCIS patients are at high or low risk of invasive progression.

• #22 Potential biomarkers of ductal carcinoma in situ progression | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-6608-y

  We propose these three genes (FGF2, GAS1, and SFRP1) as potential biomarkers of ductal carcinoma in situ progression, suggesting that their downregulation may be involved in the transition of stationary to migrating invasive epithelial cells. […] Six DEGs were found in DCISpure vs DCIScomp, being 3 of them also differentially expressed between control and DCIScomp, but not between control and DCISpure. The same 3 genes (FGF2, GAS1, and SFRP1) showed distinct gene expression profiles between noninvasive and invasive groups. Thus, suggesting their involvement in DCIS progression. […] The 3 DEGs more likely involved in DCIS progression were FGF2, GAS1, and SFPR1, all downregulated in DCIScomp. This fact suggests that progression from DCISpure to DCIScomp may use silencing mechanisms more often than activating ones. […] Functional analyses of FGF2, GAS1 and SFRP1 suggests a role in DCIS progression, being negative regulators of cell cycle G1/S transition, Hh signaling, and the Wnt pathway, respectively. We propose that downregulation favors DCIS progression.

• #23 Potential biomarkers of ductal carcinoma in situ progression | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-6608-y

  We propose these three genes (FGF2, GAS1, and SFRP1) as potential biomarkers of ductal carcinoma in situ progression, suggesting that their downregulation may be involved in the transition of stationary to migrating invasive epithelial cells. […] Six DEGs were found in DCISpure vs DCIScomp, being 3 of them also differentially expressed between control and DCIScomp, but not between control and DCISpure. The same 3 genes (FGF2, GAS1, and SFRP1) showed distinct gene expression profiles between noninvasive and invasive groups. Thus, suggesting their involvement in DCIS progression. […] The 3 DEGs more likely involved in DCIS progression were FGF2, GAS1, and SFPR1, all downregulated in DCIScomp. This fact suggests that progression from DCISpure to DCIScomp may use silencing mechanisms more often than activating ones. […] Functional analyses of FGF2, GAS1 and SFRP1 suggests a role in DCIS progression, being negative regulators of cell cycle G1/S transition, Hh signaling, and the Wnt pathway, respectively. We propose that downregulation favors DCIS progression.

• #24 Potential biomarkers of ductal carcinoma in situ progression | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-6608-y

  We propose these three genes (FGF2, GAS1, and SFRP1) as potential biomarkers of ductal carcinoma in situ progression, suggesting that their downregulation may be involved in the transition of stationary to migrating invasive epithelial cells. […] Six DEGs were found in DCISpure vs DCIScomp, being 3 of them also differentially expressed between control and DCIScomp, but not between control and DCISpure. The same 3 genes (FGF2, GAS1, and SFRP1) showed distinct gene expression profiles between noninvasive and invasive groups. Thus, suggesting their involvement in DCIS progression. […] The 3 DEGs more likely involved in DCIS progression were FGF2, GAS1, and SFPR1, all downregulated in DCIScomp. This fact suggests that progression from DCISpure to DCIScomp may use silencing mechanisms more often than activating ones. […] Functional analyses of FGF2, GAS1 and SFRP1 suggests a role in DCIS progression, being negative regulators of cell cycle G1/S transition, Hh signaling, and the Wnt pathway, respectively. We propose that downregulation favors DCIS progression.

• #25 Ductal Carcinoma In Situ of the Breast

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4484537/

  Increased exposure to estrogen, related to use of oral contraceptive (OC) pills, nulliparity, older age at first birth, or use of hormone replacement therapy (HRT) after menopause are associated with an increased risk for DCIS. Familial factors include family history of DCIS/invasive cancer. Mutations in the BRCA1 or BRCA2 genes have been implicated, which significantly increase the risk of developing DCIS/invasive disease. […] With ongoing research and development of new drugs, as well as the better understanding about the pathogenesis of the condition, better and more effective modalities of treatment should soon become available.

• #26 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Similar epidemiologic risk factors to invasive breast cancer, including older age, family history of breast cancer, nulliparity, late age at first birth, late menopause, elevated body mass index, high mammographic breast density, postmenopausal hormonal therapy use and genetic risk factors (e.g. BRCA1/2) (Mol Oncol 2010;4:357, Clinics (Sao Paulo) 2013;68:674, J Transl Med 2015;13:335) […] Represents 20 – 25% of newly diagnosed breast cancers in the United States (CA Cancer J Clin 2017;67:7, Am Surg 2018;84:1) […] 3.3 – 5.9% of women with DCIS carry a germline mutation in BRCA1 or BRCA2 and prevalence of BRCA mutation is significantly greater in women diagnosed with DCIS before the age 50 and personal or family history of breast cancer (JAMA 2005;293:964, Cancer Prev Res (Phila) 2010;3:1579, J Clin Oncol 2002;20:1480)

• #27 Ductal Carcinoma In Situ (DCIS) – National Breast Cancer Foundation

  https://www.nationalbreastcancer.org/dcis/

  Like other types of breast cancer, the exact cause of DCIS is unknown. However, there are risk factors that may increase the chance of developing DCIS as well as other types of breast cancer. Risk factors for breast cancer include genetic risk factors and environmental & lifestyle risk factors. […] Genetic risk factors for DCIS include: Gender: Women are nearly 100 times more likely to develop breast cancer than men. Age: The risk of developing DCIS increases with age. DCIS risk is highest in women between the ages of 65 and 69, though it can occur at any age. Family history: If a first-degree relative, such as a mother, sister, father, or child, was diagnosed with breast or ovarian cancer, there is a higher risk of developing breast cancer. […] Environmental and lifestyle risk factors for DCIS include: Lack of physical activity: A sedentary lifestyle can increase the risk of breast cancer. Obesity: Being overweight or obese can increase the risk of breast cancer, especially for older women. Poor diet: A diet low in fruits and vegetables can increase the risk of breast cancer.

• #28 Ductal Carcinoma In Situ (DCIS) – National Breast Cancer Foundation

  https://www.nationalbreastcancer.org/dcis/

  Like other types of breast cancer, the exact cause of DCIS is unknown. However, there are risk factors that may increase the chance of developing DCIS as well as other types of breast cancer. Risk factors for breast cancer include genetic risk factors and environmental & lifestyle risk factors. […] Genetic risk factors for DCIS include: Gender: Women are nearly 100 times more likely to develop breast cancer than men. Age: The risk of developing DCIS increases with age. DCIS risk is highest in women between the ages of 65 and 69, though it can occur at any age. Family history: If a first-degree relative, such as a mother, sister, father, or child, was diagnosed with breast or ovarian cancer, there is a higher risk of developing breast cancer. […] Environmental and lifestyle risk factors for DCIS include: Lack of physical activity: A sedentary lifestyle can increase the risk of breast cancer. Obesity: Being overweight or obese can increase the risk of breast cancer, especially for older women. Poor diet: A diet low in fruits and vegetables can increase the risk of breast cancer.

• #29 Ductal Carcinoma In Situ of the Breast

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4484537/

  Increased exposure to estrogen, related to use of oral contraceptive (OC) pills, nulliparity, older age at first birth, or use of hormone replacement therapy (HRT) after menopause are associated with an increased risk for DCIS. Familial factors include family history of DCIS/invasive cancer. Mutations in the BRCA1 or BRCA2 genes have been implicated, which significantly increase the risk of developing DCIS/invasive disease. […] With ongoing research and development of new drugs, as well as the better understanding about the pathogenesis of the condition, better and more effective modalities of treatment should soon become available.

• #30

  https://www.advocatehealth.com/health-services/cancer-institute/cancers-we-treat/breast-cancer/ductal-carcinoma-in-situ

  If you’ve had radiation therapy to the chest, particularly during childhood or adolescence, it increases your risk of developing DCIS later in life. […] Factors that affect hormone levels, such as early menstruation, late menopause, never giving birth or having a first child after the age of 30, and using hormone replacement therapy for an extended period, may increase the risk of DCIS. […] Women with dense breast tissue, as seen on mammograms, have a higher risk of developing both DCIS and invasive breast cancer. […] Regular breast self-exams and mammograms are crucial for early detection and treatment of DCIS and other types of breast cancer. […] Diagnosing DCIS can be tricky since it typically doesn’t have any noticeable symptoms. […] A stereotactic breast biopsy removes a small tissue sample through a hollow needle from an area where an abnormality was seen on a mammogram.

• #31 Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation | Modern Pathology

  https://www.nature.com/articles/modpathol201040

  Ductal carcinoma in situ (DCIS) is a heterogeneous, unicentric precursor of invasive breast cancer, which is frequently identified through mammographic breast screening programs. […] It is now generally accepted that DCIS is not one entity but rather a heterogeneous group of lesions clinically, radiologically, morphologically and genetically. […] This heterogeneity adds complexity to the pathologist’s role, in macroscopic specimen handling, and microscopic diagnosis and prognostic feature assessment. […] The microscopic heterogeneity of DCIS has led to the development of a number of systems for classification. […] Despite the additional effort that is required to obtain better reproducibility of grading of DCIS, as noted above one advantage of classifying DCIS according to cytonuclear grade is that there is less commonly a variation within an individual lesion.

• #32 Breast Ductal Carcinoma in Situ – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567766/

  DCIS is a clonal proliferation of epithelial cells in the breast ductal-lobular unit confined to the myoepithelial cell basement membrane. This confinement demarcates it from invasive breast carcinoma. […] DCIS is classified into 3 nuclear grades, which are designated as low, intermediate, or high. Low nuclear grade DCIS is characterized by small cells with uniform size and shape and inconspicuous nucleoli. High nuclear grade DCIS comprises large cells with pleomorphic nuclei, prominent nucleoli, and frequent mitosis. […] DCIS, with a high nuclear grade, has more of a likelihood of developing into invasive breast carcinoma. […] The surgical approach to DCIS is broadly categorized into 2 categories: 1) breast conservation and 2) mastectomy. […] Treatment for DCIS is multimodal and involves a combination of surgery, radiation therapy, and hormone therapy that is personalized to the patient’s specific diagnosis and preferences.

• #33 Breast Ductal Carcinoma in Situ | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35923

  DCIS is a clonal proliferation of epithelial cells in the breast ductal-lobular unit confined to the myoepithelial cell basement membrane. This confinement demarcates it from invasive breast carcinoma. […] DCIS, with a high nuclear grade, has more of a likelihood of developing into invasive breast carcinoma. […] DCIS is classified into 3 nuclear grades, which are designated as low, intermediate, or high. Low nuclear grade DCIS is characterized by small cells with uniform size and shape and inconspicuous nucleoli. High nuclear grade DCIS comprises large cells with pleomorphic nuclei, prominent nucleoli, and frequent mitosis. […] DCIS treatment is multifaceted and should be tailored to the patient based on pathology, overall health, comorbidities, age, genetics, cosmetic concerns, hormone receptor status, medical access, social support, and patient preference.

• #34 Breast Ductal Carcinoma in Situ – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567766/

  DCIS is a clonal proliferation of epithelial cells in the breast ductal-lobular unit confined to the myoepithelial cell basement membrane. This confinement demarcates it from invasive breast carcinoma. […] DCIS is classified into 3 nuclear grades, which are designated as low, intermediate, or high. Low nuclear grade DCIS is characterized by small cells with uniform size and shape and inconspicuous nucleoli. High nuclear grade DCIS comprises large cells with pleomorphic nuclei, prominent nucleoli, and frequent mitosis. […] DCIS, with a high nuclear grade, has more of a likelihood of developing into invasive breast carcinoma. […] The surgical approach to DCIS is broadly categorized into 2 categories: 1) breast conservation and 2) mastectomy. […] Treatment for DCIS is multimodal and involves a combination of surgery, radiation therapy, and hormone therapy that is personalized to the patient’s specific diagnosis and preferences.

• #35 Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation | Modern Pathology

  https://www.nature.com/articles/modpathol201040

  Indeed, genetic studies suggest that low- and-high grade DCIS have different alterations, in keeping with the concept that this is a group of diseases. […] It should be noted, however, that an alternate finding is that a mixture of grades and biomarker expression may frequently be seen within an individual case of DCIS. […] Grade of DCIS in surgical excisions relates to risk of local recurrence and to be relatively reproducible; the histological grade of DCIS in core biopsy specimens is also clinically relevant with regard to the likelihood of there being radiologically unsuspected invasion. […] The architectural growth pattern of the DCIS, the presence of necrosis, young age of patient and symptomatic detection have been reported to be poor prognostic factors for DCIS and to correlate with likelihood of local recurrence of disease, as has larger lesion size and in particular the presence of involved margins.

• #36 Case: Ductal Carcinoma In Situ – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/case-ductal-carcinoma-situ

  Ductal carcinoma in situ (DCIS) is considered a noninvasive, precursor lesion to invasive breast cancer. The basic pathologic definition of DCIS is the presence of malignant epithelial cells within the mammary ducts and without invasion into or passed the basement membrane. […] The incidence of DCIS has increased with the advent of screening mammography. Prior to the establishment of screening mammography, DCIS accounted for only 5% of breast cancers; this number has risen to nearly 30% due to screening mammography. […] There are several risk factors associated with DCIS. The most significant of these is age, with the vast majority of diagnoses occurring at age 50 years and peak incidence in the 65-69 age range. […] On pathology, DCIS is categorized by architecture and nuclear grading. Due to the heterogeneity of DCIS lesions, there are a few recognized microscopic architectural patterns, including comedo, cribriform, micropapillary, solid, and mixed subtypes.

• #37 Case: Ductal Carcinoma In Situ – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/case-ductal-carcinoma-situ

  Ductal carcinoma in situ (DCIS) is considered a noninvasive, precursor lesion to invasive breast cancer. The basic pathologic definition of DCIS is the presence of malignant epithelial cells within the mammary ducts and without invasion into or passed the basement membrane. […] The incidence of DCIS has increased with the advent of screening mammography. Prior to the establishment of screening mammography, DCIS accounted for only 5% of breast cancers; this number has risen to nearly 30% due to screening mammography. […] There are several risk factors associated with DCIS. The most significant of these is age, with the vast majority of diagnoses occurring at age 50 years and peak incidence in the 65-69 age range. […] On pathology, DCIS is categorized by architecture and nuclear grading. Due to the heterogeneity of DCIS lesions, there are a few recognized microscopic architectural patterns, including comedo, cribriform, micropapillary, solid, and mixed subtypes.

• #38 Case: Ductal Carcinoma In Situ – Radiology | UCLA Health

  https://www.uclahealth.org/departments/radiology/education/breast-imaging-teaching-resources/cases/case-ductal-carcinoma-situ

  Despite this problem, there is value in identifying architectural subtypes from a clinical perspective. Micropapillary DCIS is more often multiquadrant compared to comedo-type patterns. […] Due to the commonly mixed presentation of architectural subtypes of DCIS, newer systems of classification place an emphasis on nuclear grade. In general, DCIS is defined as monomorphic cells within the ductal lumen involving the TDLU that grow towards the nipple. […] The mainstay of treatment for DCIS is surgical resection. Surgical resection (breast-conserving lumpectomy or mastectomy) may also be paired with sentinel lymph node biopsy if the patient is high risk, there is a large component of high-grade DCIS, or patient is undergoing mastectomy.

• #39 Lattice-Based Model of Ductal Carcinoma In Situ Suggests Rules for Breast Cancer Progression to an Invasive State | PLOS Computational Biology

  https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1003997

  Ductal carcinoma in situ (DCIS) is a heterogeneous group of non-invasive lesions of the breast that result from abnormal proliferation of mammary epithelial cells. Pathologists characterize DCIS by four tissue morphologies (micropapillary, cribriform, solid, and comedo), but the underlying mechanisms that distinguish the development and progression of these morphologies are not well understood. […] We found that the relative rates of cell proliferation and apoptosis governed which of the four morphologies emerged. High proliferation and low apoptosis favored the emergence of solid and comedo morphologies. In contrast, low proliferation and high apoptosis led to the micropapillary morphology, whereas high proliferation and high apoptosis led to the cribriform morphology. […] Importantly, cribriform and comedo appear to be the ultimate morphologies of DCIS.

• #40 Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation | Modern Pathology

  https://www.nature.com/articles/modpathol201040

  Thus, the presently recognized pathological prognostic factors for local recurrence of DCIS, nuclear grade, presence/absence of necrosis and architectural pattern(s), size/extent of DCIS and distance to excision margins/margin status should all be included in the pathology report. […] There is abundant research being undertaken on the profiles of precursor lesions of invasive breast cancer, but as yet no biomarkers have been convincingly shown, and validated, to predict the behavior of DCIS.

• #41 Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation | Modern Pathology

  https://www.nature.com/articles/modpathol201040

  Thus, the presently recognized pathological prognostic factors for local recurrence of DCIS, nuclear grade, presence/absence of necrosis and architectural pattern(s), size/extent of DCIS and distance to excision margins/margin status should all be included in the pathology report. […] There is abundant research being undertaken on the profiles of precursor lesions of invasive breast cancer, but as yet no biomarkers have been convincingly shown, and validated, to predict the behavior of DCIS.

• #42 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Women diagnosed with DCIS have 10 times higher risk of developing ipsilateral invasive breast if untreated (N Engl J Med 2004;350:1430, Cancer 1982;49:751) […] 36 – 53% of low grade DCIS lesions progress to invasive lesions if untreated (Mod Pathol 2015;28:662, Cancer 1980;46:919) […] Risk of progression of untreated high grade DCIS to invasive carcinoma is not well characterized as most clinically detected high grade DCIS is excised surgically (N Engl J Med 2004;350:1430) […] Long term outcome meta analysis study of DCIS showed a 15 year total local recurrence rate of 40% with 28% recurring as invasive disease (BMC Cancer 2015;15:890) […] Positive surgical margins, high nuclear grade, large lesion size, comedo necrosis and young age (< 45 years) reported as the most important clinical pathologic predictors associated with local recurrence and prognosis (J Clin Oncol 1996;14:754, Int J Radiat Oncol Biol Phys 2001;50:991, Cancer 1999;85:616, J Clin Oncol 2006;24:3381, Cancer 2005;103:2481, Breast Cancer Res Treat 2008;109:405, Eur J Cancer 2007;43:291, Breast J 2005;11:242) [...] Low grade DCIS and high grade DCIS are genetically distinct [...] High grade DCIS has similar molecular profile as invasive breast cancer (Cancer Res 2015;75:3980).

• #43 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Women diagnosed with DCIS have 10 times higher risk of developing ipsilateral invasive breast if untreated (N Engl J Med 2004;350:1430, Cancer 1982;49:751) […] 36 – 53% of low grade DCIS lesions progress to invasive lesions if untreated (Mod Pathol 2015;28:662, Cancer 1980;46:919) […] Risk of progression of untreated high grade DCIS to invasive carcinoma is not well characterized as most clinically detected high grade DCIS is excised surgically (N Engl J Med 2004;350:1430) […] Long term outcome meta analysis study of DCIS showed a 15 year total local recurrence rate of 40% with 28% recurring as invasive disease (BMC Cancer 2015;15:890) […] Positive surgical margins, high nuclear grade, large lesion size, comedo necrosis and young age (< 45 years) reported as the most important clinical pathologic predictors associated with local recurrence and prognosis (J Clin Oncol 1996;14:754, Int J Radiat Oncol Biol Phys 2001;50:991, Cancer 1999;85:616, J Clin Oncol 2006;24:3381, Cancer 2005;103:2481, Breast Cancer Res Treat 2008;109:405, Eur J Cancer 2007;43:291, Breast J 2005;11:242) [...] Low grade DCIS and high grade DCIS are genetically distinct [...] High grade DCIS has similar molecular profile as invasive breast cancer (Cancer Res 2015;75:3980).

• #44 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Women diagnosed with DCIS have 10 times higher risk of developing ipsilateral invasive breast if untreated (N Engl J Med 2004;350:1430, Cancer 1982;49:751) […] 36 – 53% of low grade DCIS lesions progress to invasive lesions if untreated (Mod Pathol 2015;28:662, Cancer 1980;46:919) […] Risk of progression of untreated high grade DCIS to invasive carcinoma is not well characterized as most clinically detected high grade DCIS is excised surgically (N Engl J Med 2004;350:1430) […] Long term outcome meta analysis study of DCIS showed a 15 year total local recurrence rate of 40% with 28% recurring as invasive disease (BMC Cancer 2015;15:890) […] Positive surgical margins, high nuclear grade, large lesion size, comedo necrosis and young age (< 45 years) reported as the most important clinical pathologic predictors associated with local recurrence and prognosis (J Clin Oncol 1996;14:754, Int J Radiat Oncol Biol Phys 2001;50:991, Cancer 1999;85:616, J Clin Oncol 2006;24:3381, Cancer 2005;103:2481, Breast Cancer Res Treat 2008;109:405, Eur J Cancer 2007;43:291, Breast J 2005;11:242) [...] Low grade DCIS and high grade DCIS are genetically distinct [...] High grade DCIS has similar molecular profile as invasive breast cancer (Cancer Res 2015;75:3980).

• #45 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Women diagnosed with DCIS have 10 times higher risk of developing ipsilateral invasive breast if untreated (N Engl J Med 2004;350:1430, Cancer 1982;49:751) […] 36 – 53% of low grade DCIS lesions progress to invasive lesions if untreated (Mod Pathol 2015;28:662, Cancer 1980;46:919) […] Risk of progression of untreated high grade DCIS to invasive carcinoma is not well characterized as most clinically detected high grade DCIS is excised surgically (N Engl J Med 2004;350:1430) […] Long term outcome meta analysis study of DCIS showed a 15 year total local recurrence rate of 40% with 28% recurring as invasive disease (BMC Cancer 2015;15:890) […] Positive surgical margins, high nuclear grade, large lesion size, comedo necrosis and young age (< 45 years) reported as the most important clinical pathologic predictors associated with local recurrence and prognosis (J Clin Oncol 1996;14:754, Int J Radiat Oncol Biol Phys 2001;50:991, Cancer 1999;85:616, J Clin Oncol 2006;24:3381, Cancer 2005;103:2481, Breast Cancer Res Treat 2008;109:405, Eur J Cancer 2007;43:291, Breast J 2005;11:242) [...] Low grade DCIS and high grade DCIS are genetically distinct [...] High grade DCIS has similar molecular profile as invasive breast cancer (Cancer Res 2015;75:3980).

• #46 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  Molecular characterization of DCIS can potentially bring forward biomarkers for early detection of DCIS, improve prediction of DCIS progression, and help manage patients effectively to reduce unnecessary treatment. […] This review focuses on the interplay of genetic and epigenetic alterations in cancer cells along with aberrations in the immune microenvironment that contribute to the progression of DCIS to invasive breast cancer. […] Understanding the stage-specific genomic differences may help find patterns that can predict DCIS progression. […] Importantly, they first noted that adjacent IBC had a genetic pattern almost identical to DCIS and hence suggested that DCIS are genetically advanced, direct precursors of IBC. […] While several biomarkers require further investigation and clinical validation, these studies will enrich our repertoire of potential biomarkers for DCIS progression and hopefully aid in making better clinical decisions when treating patients with DCIS.

• #47 Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation | Modern Pathology

  https://www.nature.com/articles/modpathol201040

  Indeed, genetic studies suggest that low- and-high grade DCIS have different alterations, in keeping with the concept that this is a group of diseases. […] It should be noted, however, that an alternate finding is that a mixture of grades and biomarker expression may frequently be seen within an individual case of DCIS. […] Grade of DCIS in surgical excisions relates to risk of local recurrence and to be relatively reproducible; the histological grade of DCIS in core biopsy specimens is also clinically relevant with regard to the likelihood of there being radiologically unsuspected invasion. […] The architectural growth pattern of the DCIS, the presence of necrosis, young age of patient and symptomatic detection have been reported to be poor prognostic factors for DCIS and to correlate with likelihood of local recurrence of disease, as has larger lesion size and in particular the presence of involved margins.

• #48 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  This review describes the histopathological and molecular features distinguishing high-risk ductal carcinoma in situ (DCIS) from low-risk DCIS and their progression to invasive breast cancer (IBC). […] Evidence suggests that DCIS and IBC share a largely similar genome, with comparable transcriptomes across various grades of DCIS and IBC. […] High-risk DCIS is also characterized by loss of genes that are crucial for maintaining the integrity of the myoepithelium, a physical barrier that keeps the cancer cells from invading surrounding tissue. […] High-grade DCIS is also characterized by global hypomethylation, but hypermethylation of select gene promoters also occurs. […] Several long noncoding RNAs also play a role in driving the premalignant phenotypic changes in normal breast epithelial and DCIS cells.

• #49 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  The interplay between cancer cells and immune cells plays a pivotal role in cancer development and progression. […] Understanding these critical immune alterations that occur during the progression of preinvasive DCIS to invasive breast cancer will help differentiate high-risk DCIS from those with a low risk of progression. […] A key feature of DCIS progression is the loss of the surrounding ductal epithelium, which limits the exposure of ductal cancer cells to surrounding immune cells. […] Disruption of the myoepithelial layer, that forms a physical barrier, is a hallmark of progression of DCIS to invasive breast carcinoma. […] The impact of these epigenetic factors becomes clearer with a subsequent increase in breast cancer rate of Asian women living in Western countries. […] Numerous studies provide evidence that DNA methylation of gene promoters is an early event, and a majority of DNA methylation changes have already occurred prior to invasive breast carcinoma.

• #50 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  These findings point towards DCIS to be as advanced as IBC in term of epigenetic changes, higher grade DCIS was not found to have significantly higher methylation levels of glutathione s-transferase pi 1 (GSTP1) and CDKN2A (p16) compared to low grade DCIS. […] LncRNAs have been widely reported to play an instrumental role in gene regulation and cancer progression.

• #51 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  The interplay between cancer cells and immune cells plays a pivotal role in cancer development and progression. […] Understanding these critical immune alterations that occur during the progression of preinvasive DCIS to invasive breast cancer will help differentiate high-risk DCIS from those with a low risk of progression. […] A key feature of DCIS progression is the loss of the surrounding ductal epithelium, which limits the exposure of ductal cancer cells to surrounding immune cells. […] Disruption of the myoepithelial layer, that forms a physical barrier, is a hallmark of progression of DCIS to invasive breast carcinoma. […] The impact of these epigenetic factors becomes clearer with a subsequent increase in breast cancer rate of Asian women living in Western countries. […] Numerous studies provide evidence that DNA methylation of gene promoters is an early event, and a majority of DNA methylation changes have already occurred prior to invasive breast carcinoma.

• #52 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  The interplay between cancer cells and immune cells plays a pivotal role in cancer development and progression. […] Understanding these critical immune alterations that occur during the progression of preinvasive DCIS to invasive breast cancer will help differentiate high-risk DCIS from those with a low risk of progression. […] A key feature of DCIS progression is the loss of the surrounding ductal epithelium, which limits the exposure of ductal cancer cells to surrounding immune cells. […] Disruption of the myoepithelial layer, that forms a physical barrier, is a hallmark of progression of DCIS to invasive breast carcinoma. […] The impact of these epigenetic factors becomes clearer with a subsequent increase in breast cancer rate of Asian women living in Western countries. […] Numerous studies provide evidence that DNA methylation of gene promoters is an early event, and a majority of DNA methylation changes have already occurred prior to invasive breast carcinoma.

• #53 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #54 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent model is also supported by the fact that no clonal relatedness is observed between certain synchronous DCIS-IDC lesions located in different quadrants of the breast. […] The models for DCIS progression remain theoretical, and further research is urgently needed to understand the natural molecular feature of DCIS progression process and the clinical significance relatively.

• #55 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #56 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent lineage model hypothesizes that DCIS and IDC derive from two distinct normal epithelial cells. […] The evolutionary bottleneck model for DCIS-IDC transition hypothesizes that during the transition, only a small proportion of DCIS tumor cells with specific genetic events are selected to form a single clone, which subsequently breaks the evolutionary bottleneck and evolves into IDC. […] The multiclonal invasion model differs from the evolutionary bottleneck model in that it refers to multiple subclones escaping and co-migrating to invasive regions to generate IDC. […] The convergent phenotype model describes that subclones of different genotypes within DCIS may all give rise to an invasive phenotype to establish IDC, with concordant genomic profiles between the DCIS and related IDC.

• #57 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #58 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent lineage model hypothesizes that DCIS and IDC derive from two distinct normal epithelial cells. […] The evolutionary bottleneck model for DCIS-IDC transition hypothesizes that during the transition, only a small proportion of DCIS tumor cells with specific genetic events are selected to form a single clone, which subsequently breaks the evolutionary bottleneck and evolves into IDC. […] The multiclonal invasion model differs from the evolutionary bottleneck model in that it refers to multiple subclones escaping and co-migrating to invasive regions to generate IDC. […] The convergent phenotype model describes that subclones of different genotypes within DCIS may all give rise to an invasive phenotype to establish IDC, with concordant genomic profiles between the DCIS and related IDC.

• #59 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent lineage model hypothesizes that DCIS and IDC derive from two distinct normal epithelial cells. […] The evolutionary bottleneck model for DCIS-IDC transition hypothesizes that during the transition, only a small proportion of DCIS tumor cells with specific genetic events are selected to form a single clone, which subsequently breaks the evolutionary bottleneck and evolves into IDC. […] The multiclonal invasion model differs from the evolutionary bottleneck model in that it refers to multiple subclones escaping and co-migrating to invasive regions to generate IDC. […] The convergent phenotype model describes that subclones of different genotypes within DCIS may all give rise to an invasive phenotype to establish IDC, with concordant genomic profiles between the DCIS and related IDC.

• #60 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  The independent lineage model hypothesizes that DCIS and IDC derive from two distinct normal epithelial cells. […] The evolutionary bottleneck model for DCIS-IDC transition hypothesizes that during the transition, only a small proportion of DCIS tumor cells with specific genetic events are selected to form a single clone, which subsequently breaks the evolutionary bottleneck and evolves into IDC. […] The multiclonal invasion model differs from the evolutionary bottleneck model in that it refers to multiple subclones escaping and co-migrating to invasive regions to generate IDC. […] The convergent phenotype model describes that subclones of different genotypes within DCIS may all give rise to an invasive phenotype to establish IDC, with concordant genomic profiles between the DCIS and related IDC.

• #61 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  Emerging evidence suggests that considerable changes in the microenvironment pave the way for DCIS progression. […] Notably, different intrinsic subtypes of DCIS have been reported to be associated with distinct tumor microenvironment (TME) and evolutionary pathways to IDC. […] The crosstalk between tumor cells and TME components including MECs, immune cells, and fibroblasts synergistically drive DCIS progression. […] In summary, genomic investigations have demonstrated a close genetic connection between recurrent DCIS or IDC and their primary pure DCIS counterparts. […] The progression from DCIS to IDC remains largely obscure. […] The existence of indolent DCIS provided evidences for independent lineage model that DCIS and IDC were of independent origin. […] The gradual histological continuity, similar intrinsic subtypes, and general genetic similarity between DCIS and adjacent IDC further validates the theory.

• #62 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  However, it is commonly considered that the prognosis of DCIS is superior to IDC. […] It is therefore essential to identify the initiation of these lesions and the relationships between them; in particular, the molecular events underlying progression from DCIS to IDC warrant further investigation. […] Although the epidemiological and clinicopathological characteristics indicate the progression from DCIS to IDC, the underlying biological mechanisms remain obscure. […] Recent advancements in technology, such as single-cell sequencing, spatial transcriptomics, and artificial intelligence, have provided deeper insights into the molecular changes occurring during the transition from DCIS to IDC. […] The critical events associated with the transition from DCIS to IDC may occur in earlier lesions such as pure DCIS or possibly even in lesions preceding DCIS.

• #63 Pathology Outlines – DCIS

  https://www.pathologyoutlines.com/topic/breastmalignantDCIS.html

  Women diagnosed with DCIS have 10 times higher risk of developing ipsilateral invasive breast if untreated (N Engl J Med 2004;350:1430, Cancer 1982;49:751) […] 36 – 53% of low grade DCIS lesions progress to invasive lesions if untreated (Mod Pathol 2015;28:662, Cancer 1980;46:919) […] Risk of progression of untreated high grade DCIS to invasive carcinoma is not well characterized as most clinically detected high grade DCIS is excised surgically (N Engl J Med 2004;350:1430) […] Long term outcome meta analysis study of DCIS showed a 15 year total local recurrence rate of 40% with 28% recurring as invasive disease (BMC Cancer 2015;15:890) […] Positive surgical margins, high nuclear grade, large lesion size, comedo necrosis and young age (< 45 years) reported as the most important clinical pathologic predictors associated with local recurrence and prognosis (J Clin Oncol 1996;14:754, Int J Radiat Oncol Biol Phys 2001;50:991, Cancer 1999;85:616, J Clin Oncol 2006;24:3381, Cancer 2005;103:2481, Breast Cancer Res Treat 2008;109:405, Eur J Cancer 2007;43:291, Breast J 2005;11:242) [...] Low grade DCIS and high grade DCIS are genetically distinct [...] High grade DCIS has similar molecular profile as invasive breast cancer (Cancer Res 2015;75:3980).

• #64 Ductal Carcinoma In Situ (DCIS) | BCRF

  https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/

  Each of the molecular subtypes of invasive breast cancer can be identified in DCIS, but the prevalence of each is different. In particular, triple-negative and similar, basal-like subtypes are uncommon in DCIS. DCIS is a key intermediate in the progression to invasive breast cancer, but different subtypes grow at different rates, and not all breast cancers appear to have a long-lived DCIS stage—notably, triple-negative breast cancer. Research suggests that the rapid tumor progression that is a hallmark of triple-negative breast tumors means that there is seldom triple-negative DCIS at the time of diagnosis. […] DCIS is considered pre-invasive and an early form of breast cancer because the cells inside the duct are cancerous. However, DCIS treatment is controversial and remains a clinical challenge. If left untreated, some cases of DCIS will transform into invasive breast cancer, but it is uncertain how many. Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive.

• #65 Ductal carcinoma in situ (DCIS) | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/ductal-carcinoma-in-situ-dcis/

  DCIS is an early form of breast cancer. […] When cancer cells have developed within the ducts of the breast and remain within the ducts (in situ), it is called DCIS. The cancer cells have not yet developed the ability to spread outside these ducts into the surrounding breast tissue or to other parts of the body. […] If DCIS is not treated, the cancer cells may develop the ability to spread outside the ducts, into the surrounding breast tissue. This is known as invasive breast cancer. Invasive cancer has the potential to also spread to other parts of the body. […] Although the size and grade of the DCIS can help predict if it will become invasive, there is currently no way of knowing if this will happen. High-grade DCIS is more likely to become an invasive breast cancer and to do so over a shorter time than low-grade DCIS.

• #66 Breast Ductal Carcinoma in Situ – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567766/

  DCIS is a clonal proliferation of epithelial cells in the breast ductal-lobular unit confined to the myoepithelial cell basement membrane. This confinement demarcates it from invasive breast carcinoma. […] DCIS is classified into 3 nuclear grades, which are designated as low, intermediate, or high. Low nuclear grade DCIS is characterized by small cells with uniform size and shape and inconspicuous nucleoli. High nuclear grade DCIS comprises large cells with pleomorphic nuclei, prominent nucleoli, and frequent mitosis. […] DCIS, with a high nuclear grade, has more of a likelihood of developing into invasive breast carcinoma. […] The surgical approach to DCIS is broadly categorized into 2 categories: 1) breast conservation and 2) mastectomy. […] Treatment for DCIS is multimodal and involves a combination of surgery, radiation therapy, and hormone therapy that is personalized to the patient’s specific diagnosis and preferences.

• #67 Breast Ductal Carcinoma in Situ – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567766/

  DCIS is a clonal proliferation of epithelial cells in the breast ductal-lobular unit confined to the myoepithelial cell basement membrane. This confinement demarcates it from invasive breast carcinoma. […] DCIS is classified into 3 nuclear grades, which are designated as low, intermediate, or high. Low nuclear grade DCIS is characterized by small cells with uniform size and shape and inconspicuous nucleoli. High nuclear grade DCIS comprises large cells with pleomorphic nuclei, prominent nucleoli, and frequent mitosis. […] DCIS, with a high nuclear grade, has more of a likelihood of developing into invasive breast carcinoma. […] The surgical approach to DCIS is broadly categorized into 2 categories: 1) breast conservation and 2) mastectomy. […] Treatment for DCIS is multimodal and involves a combination of surgery, radiation therapy, and hormone therapy that is personalized to the patient’s specific diagnosis and preferences.

• #68 Breast Ductal Carcinoma in Situ – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567766/

  DCIS is staged as Tis and is Stage 0 breast cancer. Endocrine therapy is recommended if the DCIS specimen expresses estrogen or progesterone receptors. […] Given the noninvasive nature of DCIS, metastases or death in women with DCIS who are treated are rare. If untreated, however, DCIS usually transforms into invasive cancer that may be deadly.

• #69 Ductal carcinoma in situ (DCIS) | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/ductal-carcinoma-in-situ-dcis/

  The aim of treatment is to remove all the DCIS from within the breast to reduce the chance of it becoming an invasive cancer. […] After surgery, you may need other treatments. These are called adjuvant treatments and can include radiotherapy and, in some cases, hormone therapy. […] Some studies have found taking hormone therapy after surgery reduces the risk of DCIS coming back (recurrence) and the risk of invasive breast cancer developing.

• #70 Ductal Carcinoma in Situ | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/ductal-carcinoma-situ

  Ductal carcinoma in situ occurs when cells that line a milk duct undergo abnormal DNA changes that cause them to grow uncontrollably. However, the cancerous cells remain in place (in situ); they do not pass through the wall of the milk duct, invade nearby tissues or enter the lymphatic system or bloodstream. […] The current standard of care for DCIS is breast-preserving surgery, such as a lumpectomy followed by radiation therapy to help prevent a recurrence. Sometimes, a cell mass is larger than expected based on the images, in which case the patient may need a re-excision lumpectomy to remove all of the cancer. If DCIS is estrogen-receptor- or progesterone-receptor-positive, hormone therapy may be considered. Because ductal carcinoma in situ is noninvasive, systemic treatments such as chemotherapy are unnecessary.

• #71 Ductal Carcinoma in situ | Cancer Australia

  https://www.canceraustralia.gov.au/cancer-types/breast-cancer/types-breast-cancer/ductal-carcinoma-situ

  A focus of current research effort is to identify whether treatment for DCIS can vary dependent on the grade of the disease. There are currently two international clinical trials, (the LORIS trial and the LORD trial) that are investigating the “watch and wait” approach compared to immediate treatment for the management of low-grade DCIS.

• #72 Ductal carcinoma in situ (DCIS) | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/diagnosis/types-of-breast-cancer/ductal-carcinoma-in-situ-dcis/

  The aim of treatment is to remove all the DCIS from within the breast to reduce the chance of it becoming an invasive cancer. […] After surgery, you may need other treatments. These are called adjuvant treatments and can include radiotherapy and, in some cases, hormone therapy. […] Some studies have found taking hormone therapy after surgery reduces the risk of DCIS coming back (recurrence) and the risk of invasive breast cancer developing.

• #73

  https://www.advocatehealth.com/health-services/cancer-institute/cancers-we-treat/breast-cancer/ductal-carcinoma-in-situ

  If you’ve had radiation therapy to the chest, particularly during childhood or adolescence, it increases your risk of developing DCIS later in life. […] Factors that affect hormone levels, such as early menstruation, late menopause, never giving birth or having a first child after the age of 30, and using hormone replacement therapy for an extended period, may increase the risk of DCIS. […] Women with dense breast tissue, as seen on mammograms, have a higher risk of developing both DCIS and invasive breast cancer. […] Regular breast self-exams and mammograms are crucial for early detection and treatment of DCIS and other types of breast cancer. […] Diagnosing DCIS can be tricky since it typically doesn’t have any noticeable symptoms. […] A stereotactic breast biopsy removes a small tissue sample through a hollow needle from an area where an abnormality was seen on a mammogram.

• #74 Understanding ductal carcinoma in situ – Harvard Health

  https://www.health.harvard.edu/newsletter_article/understanding-ductal-carcinoma-in-situ

  Ductal carcinoma in situ (DCIS) is an overgrowth of abnormal cells in the milk ducts of the breast. It starts with the proliferation of normal cells lining the milk ducts (ductal hyperplasia); next, the cells within the duct become abnormal and rapidly multiply (atypical ductal hyperplasia); finally, abnormal cells fill the duct (DCIS). Invasive ductal breast cancer occurs when abnormal cells break out of the milk duct. […] DCIS research is directed mainly at improving treatment and, above all, at preventing progression to invasive disease. As researchers continue to study the pathology of DCIS, they are finding that certain tumor characteristics help predict the treatment most likely to reduce the chance of recurrence. For example, some forms of breast cancer require estrogen in order to grow; tumors that do are termed estrogen receptor–positive (ER-positive). Tamoxifen belongs to a class of drugs called selective estrogen-receptor modulators (SERMs), which act by blocking estrogen receptors. Tamoxifen is more likely to prevent a recurrence in women with ER-positive DCIS than in women with ER-negative disease.

• #75 Understanding ductal carcinoma in situ – Harvard Health

  https://www.health.harvard.edu/newsletter_article/understanding-ductal-carcinoma-in-situ

  The use of aromatase inhibitors, which block estrogen production in the peripheral tissues and breast tissue, is being investigated in a trial of postmenopausal women with ER-positive DCIS. For women whose DCIS is ER-negative but who have the HER-2/neu gene, researchers are exploring the use of trastuzumab (Herceptin) and lapatinib (Tykerb), which block the tumor growth factors produced by that gene. […] Another promising area of investigation involves the short-term use of chemotherapy between diagnosis and surgery to alter the DCIS, so that tissue from the surgical resection can be used by researchers to assess molecular as well as pathologic evidence of response. Agents that can induce responses in the „right direction” — for example, slow or stop the growth of abnormal cells — may then be further evaluated for their potential in treatment or prevention.

• #76 Understanding ductal carcinoma in situ – Harvard Health

  https://www.health.harvard.edu/newsletter_article/understanding-ductal-carcinoma-in-situ

  The use of aromatase inhibitors, which block estrogen production in the peripheral tissues and breast tissue, is being investigated in a trial of postmenopausal women with ER-positive DCIS. For women whose DCIS is ER-negative but who have the HER-2/neu gene, researchers are exploring the use of trastuzumab (Herceptin) and lapatinib (Tykerb), which block the tumor growth factors produced by that gene. […] Another promising area of investigation involves the short-term use of chemotherapy between diagnosis and surgery to alter the DCIS, so that tissue from the surgical resection can be used by researchers to assess molecular as well as pathologic evidence of response. Agents that can induce responses in the „right direction” — for example, slow or stop the growth of abnormal cells — may then be further evaluated for their potential in treatment or prevention.

• #77 Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-01779-3

  However, it is commonly considered that the prognosis of DCIS is superior to IDC. […] It is therefore essential to identify the initiation of these lesions and the relationships between them; in particular, the molecular events underlying progression from DCIS to IDC warrant further investigation. […] Although the epidemiological and clinicopathological characteristics indicate the progression from DCIS to IDC, the underlying biological mechanisms remain obscure. […] Recent advancements in technology, such as single-cell sequencing, spatial transcriptomics, and artificial intelligence, have provided deeper insights into the molecular changes occurring during the transition from DCIS to IDC. […] The critical events associated with the transition from DCIS to IDC may occur in earlier lesions such as pure DCIS or possibly even in lesions preceding DCIS.

• #78 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research

  https://ar.iiarjournals.org/content/45/4/1305

  Molecular characterization of DCIS can potentially bring forward biomarkers for early detection of DCIS, improve prediction of DCIS progression, and help manage patients effectively to reduce unnecessary treatment. […] This review focuses on the interplay of genetic and epigenetic alterations in cancer cells along with aberrations in the immune microenvironment that contribute to the progression of DCIS to invasive breast cancer. […] Understanding the stage-specific genomic differences may help find patterns that can predict DCIS progression. […] Importantly, they first noted that adjacent IBC had a genetic pattern almost identical to DCIS and hence suggested that DCIS are genetically advanced, direct precursors of IBC. […] While several biomarkers require further investigation and clinical validation, these studies will enrich our repertoire of potential biomarkers for DCIS progression and hopefully aid in making better clinical decisions when treating patients with DCIS.

• #79 Ductal Carcinoma in Situ: When Cancer isn’t Really Cancer

  https://www.cancercoreeurope.eu/cce-lecture-ductal-carcinoma-in-situ/

  A key finding is that DCIS shares many genomic characteristics with invasive breast cancer, shown by the team in model systems and in large clinically annotated DCIS series. […] Additionally, Wesseling discussed his work with the DIRECT DCIS Consortium, a project focused on reducing overtreatment in women in the Netherlands. Using cutting-edge integrative artificial intelligence, inspired by advancements in weather forecasting, this dynamic DCIS-risk prediction model aims to prevent unnecessary treatment for women with non-progressive DCIS, preserving their quality of life and reducing healthcare costs.

• #80 Ductal Carcinoma In Situ with Diffuse Growth Distribution: A Potentially Lethal Subtype of “Preinvasive” Disease | medRxiv

  https://www.medrxiv.org/content/10.1101/2020.09.17.20196931v1.full-text

  PURPOSE The current trend in ductal carcinoma in situ (DCIS) research is towards treatment de-escalation. Problematically, prognostic indicators for patients at high risk of breast cancer mortality (BCM), rather than recurrence, have not been identified. We aim to identify prognostic factors for the development of metastatic disease and mortality. […] Diffuse DCIS represents an uncommon but deadly subtype for whom treatment escalation, rather than de-escalation, is likely necessary. Further studies elucidating the mechanism of metastasis and best treatment course are needed. […] It remains unclear whether metastases after diagnosis of DCIS are secondary to occult disease, temporally or spatially missed foci of invasion, or a different mechanism altogether such as intraductal angiogenic processes.

• #81 Ductal carcinoma in situ (DCIS): 7 things to know | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/ductal-carcinoma-in-situ–dcis—7-things-to-know.h00-159616278.html

  Second, the imaging we do here is very sensitive, so our radiologists often pick up on things that others miss. […] Third, any time youre diagnosed with cancer, it automatically increases your odds of developing another cancer later on. […] One of the biggest questions right now regarding DCIS is, Are we overtreating this? […] This clinical trial which stands for Comparing an Operation to Monitoring, With or Without Endocrine Therapy is looking at whether patients with low-risk DCIS can delay or avoid surgery altogether with medication or endocrine therapy, plus closer observation.

• #82 Ductal Carcinoma in Situ: When Cancer isn’t Really Cancer

  https://www.cancercoreeurope.eu/cce-lecture-ductal-carcinoma-in-situ/

  Ductal carcinoma in situ (DCIS) currently accounts for 15% to 25% of all screen-detected breast cancers. However, the majority of DCIS lesions do not progress to invasive breast cancer. […] The uncertainty about which DCIS cases may evolve into breast cancer leads to widespread overtreatment of what is often a non-threatening condition. […] DCIS is a potential precursor to invasive breast cancer (IBC). More than 80% of DCIS cases are found during routine mammograms because they often show up as calcifications. Screening has led to a rise in DCIS diagnoses, but it hasn’t reduced deaths from breast cancer. In fact, 80% of DCIS cases never develop into IBC, meaning many diagnoses could lead to unnecessary treatment. This means women with DCI are subjected to unneeded hospital visits, in addition to mental health problems like anxiety and stress, affecting their quality of life.

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