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Open Access 01-07-2007 | Breast Oncology

Pathological and Biological Differences Between Screen-Detected and Interval Ductal Carcinoma in situ of the Breast

Authors: Marnix A. de Roos, MD, Bert van der Vegt, MD, Jaap de Vries, MD, PhD, Jelle Wesseling, MD, PhD, Geertruida H. de Bock, PhD

Published in: Annals of Surgical Oncology | Issue 7/2007

Abstract

Background

The incidence of ductal carcinoma in situ (DCIS) has risen dramatically with the introduction of screening mammography. The aim was to evaluate differences in pathological and biological characteristics between patients with screen-detected and interval DCIS.

Methods

From January 1992 to December 2001, 128 consecutive patients had been treated for pure DCIS at our institute. From these, 102 had been attending the Dutch breast cancer screening program. Sufficient paraffin-embedded tissue was available in 74 out of the 102 cases to evaluate biological marker expression (Her2/neu, ER, PR, p53 and cyclin D1) on tissue microarrays (TMA group). Differences in clinicopathological characteristics and marker expression between screen-detected and interval patients were evaluated. Screen-detected DCIS was classified as DCIS detected by screening mammography, when the two-year earlier examination failed to reveal an abnormality. Interval patients were classified as patients with DCIS detected within the two-year interval between two subsequent screening rounds.

Results

Screen-detected DCIS was related with linear branching and coarse granular microcalcifications on mammography (p < .001) and with high-grade DCIS according to the Van Nuys classification (p = .025). In univariate analysis, screen-detected DCIS was related with Her2/neu overexpression (odds ratio [OR] = 6.5; 95%CI 1.3–31.0; p = .020), and interval DCIS was associated with low-grade (Van Nuys, OR = 7.3; 95% CI 1.6–33.3; p = .010) and PR positivity (OR = 0.3; 95%CI 0.1–1.0; p = .042). The multivariate analysis displayed an independent relation of Her2/neu overexpression with screen-detected DCIS (OR = 12.8; 95%CI 1.6–104.0; p = .018).

Conclusions

These findings suggest that screen-detected DCIS is biologically more aggressive than interval DCIS and should not be regarded as overdiagnosis.

Voogd AC, Crommelin MA, Repelaer van Driel OJ, Nolthenius-Puylaart MC, van der Heijden LH, Coebergh JW. Trends in incidence and treatment of ductal carcinoma in situ of the breast in southeast Netherlands. Ned Tijdschr Geneeskd 2000; 14:659–63

Levi F, Te VC, Randimbison L, La Vecchia C. Trends of in situ carcinoma of the breast in Vaud, Switzerland. Eur J Cancer 1997; 33:903–6PubMedCrossRef

Ernster V, Barclay J, Kerlikowske K, Grady D, Henderson I. Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996; 275:913–8PubMedCrossRef

Ernster VL, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 2002; 94:1546–54PubMed

Jatoi I, Baum M. Mammographically detected ductal carcinoma in situ: are we over-diagnosing breast cancer? Surgery 1995; 118:188–21CrossRef

Thornton H. Consequences of breast screening. Lancet 2000; 356:1033PubMedCrossRef

Welch HG, Black WC. Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med 1997; 127:1023–8PubMed

Page DL, Dupont WD, Rogers LW, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer 1995; 76:1197–1200PubMedCrossRef

Eusebi V, Foschini MP, Cook MG, Berrino F, Azzopardi JG. Long-term follow-up of in situ carcinoma of he breast with special emphasis on clinging carcinoma. Semin Diagn Pathol 1989; 6:165–73PubMed

10.

Fisher E, Dignam J, Tan-Chiu E, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight year update of Protocol B-17. Cancer 1999; 86:429–38PubMedCrossRef

11.

Julien JP, Bijker N, Fentiman I, et al. Radiotherapy in breast conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Lancet 2000; 355:528–33PubMedCrossRef

12.

Evans A, Pinder S, Ellis I, et al. Screening-detected and symptomatic ductal carcinoma in situ: mammographic features with pathologic correlation. Radiology 1994; 191:237–40PubMed

13.

Stomper P, Conolly J. Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. Am J Radiol 1992; 159:483–5

14.

de Roos MA, Pijnappel RM, Post WJ, de Vries J, Baas PC, Groote AD. Correlation between imaging and pathology of ductal carcinoma in situ of the breast. World J Surg Oncol 2004; 2:4PubMedCrossRef

15.

Holland R, Peterse JL, Millis RR, et al. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol 1994; 11:167–80PubMed

16.

Silverstein MJ, Poller DN, Waisman JR, et al. Prognostic classification of breast ductal carcinoma in situ. Lancet 1995; 345:1154–7PubMedCrossRef

17.

Kononen J, Bubendorf L, Kallioniemi A, et al. Tissue microarrays for high-throughput molecular profiling of tumor specimens. Nat Med 1998; 4:844–7PubMedCrossRef

18.

Vos CB, Ter Haar NT, Peterse JL, Cornelisse CJ, van de Vijver MJ. Cyclin D1 gene amplification and overexpression are present in ductal carcinoma in situ of the breast. J Pathol 1999; 189:279–84CrossRef

19.

Yen MF, Tabar L, Vitak B, Smith RA, Chen HH, Duffy SW. Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening. Eur J Cancer 2003; 39:1746–54PubMedCrossRef

20.

Meijnen Ph, Peterse JL, Oldenburg LA, Woerdeman LA, Rutgers EJ. Changing patterns in diagnosis and treatment of ductal carcinoma in situ of the breast. Eur J Surg Oncol 2005; 31:833–9PubMedCrossRef

21.

Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected ductal carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989; 63:618–24PubMedCrossRef

22.

Boyages J, Delaney G, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer 1999; 85:616–28PubMedCrossRef

23.

Kerlikowske K, Mollarino A, Cha I, et al. Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy. J Natl Cancer Inst 2003; 95:1692–1702PubMed

24.

Walker RA, Dearing SJ, Brown LA. Comparison of pathological and biological features of symptomatic and mammographically detected ductal carcinoma in situ of the breast. Hum Pathol 1999; 30:943–8PubMedCrossRef

25.

Idvall I, Andersson C, Fallenius G, et al. Histopathological and cell biological factors of ductal carcinoma in situ before and after the introduction of mammographic screening. Acta Oncol 2001; 40:653–9PubMedCrossRef

26.

Evans AJ, Pinder SE, Ellis IO, Wilson AR. Screen detected ductal carcinoma in situ (DCIS): overdiagnosis or an obligate precursor of invasive disease? J Med Screen 2001; 8:149–51PubMedCrossRef

27.

Kessar P, Perry N, Vinnicombe SJ, Hussain HK, Carpenter R, Wells CA. How significant is detection of ductal carcinoma in situ in a breast screening programme? Clin Radiol 2002; 57:807–14PubMed

28.

Ho GH, Calvano JE, Bisogna M, et al. In microdissected ductal carcinoma in situ, Her-2/neu amplification, but not p53 mutation, is associated with high nuclear grade and comedo histology. Cancer 2000; 89:2153–60PubMedCrossRef

29.

Mack L, Kerkvliet N, Doig G, O’Malley FP. Relationship of a new histological categorization of ductal carcinoma in situ of the breast with size and the immunohistochemical expression of p53, c-erbB-2, bcl-2, and ki-67. Hum Pathol 1997; 28:974–9PubMedCrossRef

30.

Leal CB, Schmitt FC, Bento MJ, Maia NC, Lopes CS. Ductal carcinoma in situ of the breast. Histologic categorization and its relationship to ploidy and immunohistochemical expression of hormone receptors, p53, and c-erbB-2 protein. Cancer 1995; 75:2123–31PubMedCrossRef

31.

Boland GP, Knox WF, Bundred NJ. Molecular markers and therapeutic targets in ductal carcinoma in situ. Microsc Res Tech 2002; 59:3–11PubMedCrossRef

Title: Pathological and Biological Differences Between Screen-Detected and Interval Ductal Carcinoma in situ of the Breast
Authors: Marnix A. de Roos, MD
Bert van der Vegt, MD
Jaap de Vries, MD, PhD
Jelle Wesseling, MD, PhD
Geertruida H. de Bock, PhD
Publication date: 01-07-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 7/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9395-7

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Springer Medicine

Pathological and Biological Differences Between Screen-Detected and Interval Ductal Carcinoma in situ of the Breast

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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