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==Overview==
==Overview==


'''Ductal carcinoma''' is the most common type of breast cancer in women. Ductal carcinoma may be classified according to the Armed Forces Institute of Pathology (AFIP) into 2 groups: large cell carcinoma in situ and small cell carcinoma in situ. The pathogenesis of ductal carcinoma is characterized by the microinvasion of cancer cells limited to the ducts with no extension beyond the basement membrane. The mutation on HER2/neu has been associated with the development of ductal carcinoma. The most important cause of ductal carcinoma is mutations in the BRCA1/BRCA2 genes. On microscopic histopathological analysis, characteristic findings of ductal carcinoma, include:
'''Ductal carcinoma''' is the most common type of breast cancer in women. Ductal carcinoma may be classified according to the Armed Forces Institute of Pathology (AFIP) into 2 groups: large cell carcinoma in situ and small cell [[carcinoma in situ]]. The pathogenesis of ductal carcinoma is characterized by the microinvasion of cancer cells limited to the ducts with no extension beyond the basement membrane. The mutation on [[HER2/neu]] has been associated with the development of ductal carcinoma. The most important cause of ductal carcinoma is mutations in the BRCA1/BRCA2 genes. On microscopic histopathological analysis, characteristic findings of ductal carcinoma, include:
equal spacing of cells - "cookie cutter" look, cells line-up along lumen, and nuclear enlargement (key feature). Common risk factors in the development of ductal carcinoma, include: family history of breast cancer, mutations in BRCA1/BRCA2 gene, previous exposure to radiation therapy, increased breast density, and hormonal therapy. Surgical approaches for ductal carcinoma, include: mastectomy or breast-conserving therapy. Lumpectomy in conjunction with adjuvant chemotherapy or radiation is the most common approach to the treatment of ductal carcinoma (with negative margins). On the other hand, mastectomy is recommended for patients with extensive margins of ductal carcinoma. Effective measures for the secondary prevention of ductal carcinoma include: screening mammography for women between 50-74 years (or earlier if identified risk factors)  and periodical breast self-examination (BSE).<ref name="preventive> US Task Preventive Force. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening Accessed on April 19, 2016</ref>
equal spacing of cells - "cookie cutter" look, cells line-up along lumen, and nuclear enlargement (key feature). Common risk factors in the development of ductal carcinoma, include: family history of breast cancer, mutations in BRCA1/BRCA2 gene, previous exposure to radiation therapy, increased breast density, and [[hormonal therapy]]. Surgical approaches for ductal carcinoma, include: [[mastectomy]] or breast-conserving therapy. [[Lumpectomy]] in conjunction with adjuvant [[chemotherapy]] or [[radiation]] is the most common approach to the treatment of ductal carcinoma (with negative margins). On the other hand, [[mastectomy]] is recommended for patients with extensive margins of ductal carcinoma. Effective measures for the secondary prevention of ductal carcinoma include: screening mammography for women between 50-74 years (or earlier if identified risk factors)  and periodical breast self-examination (BSE).<ref name="preventive">US Task Preventive Force. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening Accessed on April 19, 2016</ref>


==Historical Perspective==
==Historical Perspective==
Ductal carcinoma was first described by MacCarthy in 1893.<ref name="name"> MacCarty WC. The histogenesis of cancer (carcinoma) of the breast and its clinical significance. Surg Gynecol Obstet 1913;17:441–59.</ref>
Ductal carcinoma was first described by MacCarthy in 1893.<ref name="name">MacCarty WC. The histogenesis of cancer (carcinoma) of the breast and its clinical significance. Surg Gynecol Obstet 1913;17:441–59.</ref>


==Classification==
==Classification==
Line 42: Line 42:


==Causes==
==Causes==
*The most important cause of ductal carcinoma is mutations in the BRCA1/BRCA2 genes.  
*The most important cause of ductal carcinoma is mutations in the [[BRCA1|BRCA1/BRCA2]] genes.  


==Differentiating ductal carcinoma from other Diseases==
==Differentiating ductal carcinoma from other Diseases==
*Ductal carcinoma must be differentiated from other diseases that cause nipple discharge, breast skin color change, and palpable mass such as:<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref>
*Ductal carcinoma must be differentiated from other diseases that cause [[nipple discharge]], breast skin color change, and palpable mass such as:<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref>
:*Periductal mastitis  
:*[[Mastitis|Periductal mastitis]]
:*Breast lipoma
:*[[Lipoma|Breast lipoma]]
:*Inflammatory carcinoma of breast
:*[[Inflammatory breast cancer|Inflammatory carcinoma of breast]]
:*Phyllodes tumour
:*[[Phyllodes tumor]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==
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*Ductal carcinoma is commonly observed among females between 40 to 80 years old
*Ductal carcinoma is commonly observed among females between 40 to 80 years old
*Ductal carcinoma is rarely observed among males between 60 and 70 years of age
*Ductal carcinoma is rarely observed among males between 60 and 70 years of age
*Ductal carcinoma is more commonly observed among postmenopausal women<ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Ductal carcinoma is more commonly observed among postmenopausal women<ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
===Gender===
===Gender===
*Females are significantly more commonly affected with ductal carcinoma than males.
*Females are significantly more commonly affected with ductal carcinoma than males.
Line 69: Line 69:
:*Previous exposure to radiation therapy  
:*Previous exposure to radiation therapy  
:*Increased breast density
:*Increased breast density
:*Hormonal therapy
:*[[Hormonal therapy]]
:*Nulliparity  
:*Nulliparity  
:*Genetic syndromes (eg. Li-Fraumeni, Cowden syndrome)
:*Genetic syndromes (eg. [[Li-Fraumeni syndrome|Li-Fraumeni]], [[Cowden syndrome]])
:*Obesity
:*[[Obesity]]


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
Line 80: Line 80:
*The most common complication of ductal carcinoma is lymphedema.  
*The most common complication of ductal carcinoma is lymphedema.  
*Prognosis generally depends on the histological subtype.<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref>
*Prognosis generally depends on the histological subtype.<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref>
:*In general, the 20-year mortality rate among patients with ductal carcinoma is approximately 3.3%.  
:*In general, the 20-year mortality rate among patients with ductal carcinoma is approximately 3.3%.<ref name="pmid20071685">{{cite journal |vauthors=Virnig BA, Tuttle TM, Shamliyan T, Kane RL |title=Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes |journal=J. Natl. Cancer Inst. |volume=102 |issue=3 |pages=170–8 |year=2010 |pmid=20071685 |doi=10.1093/jnci/djp482 |url=}}</ref>
:*Factors related with worse prognosis, include: young age at diagnosis, black ethnicity, and high grade cancer.<ref name="pmid20071685">{{cite journal |vauthors=Virnig BA, Tuttle TM, Shamliyan T, Kane RL |title=Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes |journal=J. Natl. Cancer Inst. |volume=102 |issue=3 |pages=170–8 |year=2010 |pmid=20071685 |doi=10.1093/jnci/djp482 |url=}}</ref>
:*Factors related with worse prognosis, include: young age at diagnosis, black ethnicity, and high grade cancer.<ref name="pmid20071685">{{cite journal |vauthors=Virnig BA, Tuttle TM, Shamliyan T, Kane RL |title=Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes |journal=J. Natl. Cancer Inst. |volume=102 |issue=3 |pages=170–8 |year=2010 |pmid=20071685 |doi=10.1093/jnci/djp482 |url=}}</ref>


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=== Symptoms ===
=== Symptoms ===
*Ductal carcinoma is usually asymptomatic.
*Ductal carcinoma is usually asymptomatic.
*Symptoms of ductal carcinoma may include the following:<ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Symptoms of ductal carcinoma may include the following:<ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
:*Nipple discharge
:*[[Nipple discharge]]
::*Skin color changes
::*Skin color changes
::*Warm and thickened
::*Warm and thickened
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*Patients with ductal carcinoma usually are well-appearing.  
*Patients with ductal carcinoma usually are well-appearing.  
:*Physical examination may show no specific physical findings.  
:*Physical examination may show no specific physical findings.  
*In some cases, it may be remarkable for:<ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*In some cases, it may be remarkable for:<ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
:*Palpable mass
:*Palpable mass


Line 105: Line 105:
===Imaging Findings===
===Imaging Findings===
*Mammography is the imaging modality of choice for ductal carcinoma.<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref>
*Mammography is the imaging modality of choice for ductal carcinoma.<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref>
*On mammography, findings of ductal carcinoma, include:<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref><ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*On mammography, findings of ductal carcinoma, include:<ref name="pmid16319971">{{cite journal |vauthors=Erbas B, Provenzano E, Armes J, Gertig D |title=The natural history of ductal carcinoma in situ of the breast: a review |journal=Breast Cancer Res. Treat. |volume=97 |issue=2 |pages=135–44 |year=2006 |pmid=16319971 |doi=10.1007/s10549-005-9101-z |url=}}</ref><ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
:*Calcifications (most common)  
:*Calcifications (most common)  
:*Simple mass  
:*Simple mass  
Line 114: Line 114:
Image:Mammo breast cancer.jpg|Normal (left) versus cancerous (right) mammography image.
Image:Mammo breast cancer.jpg|Normal (left) versus cancerous (right) mammography image.
</gallery>
</gallery>
*On ultrasound, findings of ductal carcinoma,  include:<ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*On ultrasound, findings of ductal carcinoma,  include:<ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
:*Microlobulated mild hypoechoic mass
:*Microlobulated mild hypoechoic mass


Line 127: Line 127:
'''Hormonal Therapy'''
'''Hormonal Therapy'''
:*Selective estrogen receptor modulators, such as:  
:*Selective estrogen receptor modulators, such as:  
:*Tamoxifen  
:*[[Tamoxifen]]
:*Raloxifene
:*[[Raloxifene]]
'''Targeted Therapy'''
'''Targeted Therapy'''
:*HER2-directed therapy
:*HER2-directed therapy
:*Trastuzumab  
:*[[Trastuzumab]]
*The primary goal of medical therapy is to reduce the risk of ipsilateral or contralateral breast invasion and also decreases the risk of recurrence.<ref name="pmid20071685">{{cite journal |vauthors=Virnig BA, Tuttle TM, Shamliyan T, Kane RL |title=Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes |journal=J. Natl. Cancer Inst. |volume=102 |issue=3 |pages=170–8 |year=2010 |pmid=20071685 |doi=10.1093/jnci/djp482 |url=}}</ref>
*The primary goal of medical therapy is to reduce the risk of ipsilateral or contralateral breast invasion and also decreases the risk of recurrence.<ref name="pmid20071685">{{cite journal |vauthors=Virnig BA, Tuttle TM, Shamliyan T, Kane RL |title=Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes |journal=J. Natl. Cancer Inst. |volume=102 |issue=3 |pages=170–8 |year=2010 |pmid=20071685 |doi=10.1093/jnci/djp482 |url=}}</ref>


=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for ductal carcinoma.<ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Surgery is the mainstay of therapy for ductal carcinoma.<ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Surgical approaches for ductal carcinoma, include: mastectomy or breast-conserving therapy  
*Surgical approaches for ductal carcinoma, include: mastectomy or breast-conserving therapy  
*Lumpectomy in conjunction with adjuvant chemotherapy or radiation is the most common approach to the treatment of ductal carcinoma (with negative margins)
*Lumpectomy in conjunction with adjuvant chemotherapy or radiation is the most common approach to the treatment of ductal carcinoma (with negative margins)
Line 141: Line 141:


=== Prevention ===
=== Prevention ===
*Effective measures for the secondary prevention of ductal carcinoma include: screening mammography for women between 50-74 years (or earlier if identified risk factors)  and periodical breast self-examination (BSE).<ref name="preventive> US Task Preventive Force. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening Accessed on April 19, 2016</ref><ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Effective measures for the secondary prevention of ductal carcinoma include: screening mammography for women between 50-74 years (or earlier if identified risk factors)  and periodical breast self-examination (BSE).<ref name="preventive">US Task Preventive Force. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening Accessed on April 19, 2016</ref><ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Once diagnosed and successfully treated, patients with ductal carcinoma are followed-up every 3, 6, or 12 months depending on individual assessment.<ref name="radiopedia> Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>
*Once diagnosed and successfully treated, patients with ductal carcinoma are followed-up every 3, 6, or 12 months depending on individual assessment.<ref name="radiopedia">Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016 </ref>


==References==
==References==

Revision as of 19:49, 19 April 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Intraductal hyperplasia; IDH; Atypical ductal hyperplasia; Comedocarcinoma; Duct cell carcinoma; Duct carcinoma

Overview

Ductal carcinoma is the most common type of breast cancer in women. Ductal carcinoma may be classified according to the Armed Forces Institute of Pathology (AFIP) into 2 groups: large cell carcinoma in situ and small cell carcinoma in situ. The pathogenesis of ductal carcinoma is characterized by the microinvasion of cancer cells limited to the ducts with no extension beyond the basement membrane. The mutation on HER2/neu has been associated with the development of ductal carcinoma. The most important cause of ductal carcinoma is mutations in the BRCA1/BRCA2 genes. On microscopic histopathological analysis, characteristic findings of ductal carcinoma, include: equal spacing of cells - "cookie cutter" look, cells line-up along lumen, and nuclear enlargement (key feature). Common risk factors in the development of ductal carcinoma, include: family history of breast cancer, mutations in BRCA1/BRCA2 gene, previous exposure to radiation therapy, increased breast density, and hormonal therapy. Surgical approaches for ductal carcinoma, include: mastectomy or breast-conserving therapy. Lumpectomy in conjunction with adjuvant chemotherapy or radiation is the most common approach to the treatment of ductal carcinoma (with negative margins). On the other hand, mastectomy is recommended for patients with extensive margins of ductal carcinoma. Effective measures for the secondary prevention of ductal carcinoma include: screening mammography for women between 50-74 years (or earlier if identified risk factors) and periodical breast self-examination (BSE).[1]

Historical Perspective

Ductal carcinoma was first described by MacCarthy in 1893.[2]

Classification

  • Ductal carcinoma may be classified according to the Armed Forces Institute of Pathology (AFIP) into 2 groups:[3]
  • Large cell
  • More aggressive form
  • Also referred to as comedocarcinoma
  • Small cell
  • Less aggressive
  • Subtypes include cribriform, micropapillary, papillary, and solid in situ.
  • Other variants of ductal carcinoma include, non-DCIS entities.

Pathophysiology

  • The pathogenesis of ductal carcinoma is characterized by the microinvasion of cancer cells limited to the ducts with no extension beyond the basement membrane.
  • The mutation on HER2/neu has been associated with the development of ductal carcinoma.
  • On gross pathology, characteristic findings of ductal carcinoma, include:[3]
  • White
  • Firm stellate lesion
  • On microscopic histopathological analysis, characteristic findings of ductal carcinoma, include:
  • Equal spacing of cells - "cookie cutter" look.
  • Cells line-up along lumen/glandular spaces - form "Roman briges".
  • Nuclear enlargement (key feature)
  • The image below demonstrates histopathological findings of ductal carcinoma.
  • Ductal carcinoma: cells line-up along lumen (form "Roman briges")

    Ductal carcinoma: cells line-up along lumen (form "Roman briges")

Causes

  • The most important cause of ductal carcinoma is mutations in the BRCA1/BRCA2 genes.

Differentiating ductal carcinoma from other Diseases

  • Ductal carcinoma must be differentiated from other diseases that cause nipple discharge, breast skin color change, and palpable mass such as:[4]

Epidemiology and Demographics

  • The prevalence of ductal carcinoma is approximately 32.5 per 100,000 women worldwide.[3]

Age

  • Ductal carcinoma is commonly observed among females between 40 to 80 years old
  • Ductal carcinoma is rarely observed among males between 60 and 70 years of age
  • Ductal carcinoma is more commonly observed among postmenopausal women[5]

Gender

  • Females are significantly more commonly affected with ductal carcinoma than males.

Race

  • There is no racial predilection for ductal carcinoma.

Risk Factors

  • Common risk factors in the development of ductal carcinoma, include:[4]

Natural History, Complications and Prognosis

  • The majority of patients with ductal carcinoma remain asymptomatic for years.[3]
  • Early clinical features include skin color change or nipple discharge.
  • If left untreated, the majority of patients with ductal carcinoma may progress to develop lymph node invasion, and metastasis.
  • The most common complication of ductal carcinoma is lymphedema.
  • Prognosis generally depends on the histological subtype.[4]
  • In general, the 20-year mortality rate among patients with ductal carcinoma is approximately 3.3%.[3]
  • Factors related with worse prognosis, include: young age at diagnosis, black ethnicity, and high grade cancer.[3]

Diagnosis

Symptoms

  • Ductal carcinoma is usually asymptomatic.
  • Symptoms of ductal carcinoma may include the following:[5]
  • Skin color changes
  • Warm and thickened
  • Skin of an orange appearance
  • Nipple retraction

Physical Examination

  • Patients with ductal carcinoma usually are well-appearing.
  • Physical examination may show no specific physical findings.
  • In some cases, it may be remarkable for:[5]
  • Palpable mass

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of ductal carcinoma, include:[3]
  • Positive/negative estrogen receptor (ER) and progesterone receptor (PR) expression

Imaging Findings

  • Mammography is the imaging modality of choice for ductal carcinoma.[4]
  • On mammography, findings of ductal carcinoma, include:[4][5]
  • Calcifications (most common)
  • Simple mass
  • Soft-tissue opacity
  • Asymmetry without calcification
  • The image below demonstrates findings compatible with ductal carcinoma.
  • Normal (left) versus cancerous (right) mammography image.

    Normal (left) versus cancerous (right) mammography image.

  • On ultrasound, findings of ductal carcinoma, include:[5]
  • Microlobulated mild hypoechoic mass

Other Diagnostic Studies

  • Ductal carcinoma may also be diagnosed using biopsy.
  • Indications for biopsy, include:
  • Lesion limited to one quadrant or section of the breast

Treatment

Medical Therapy

  • The mainstay of therapies for ductal carcinoma are divided into 2 groups: hormonal therapy and targeted therapy.[3]

Hormonal Therapy

Targeted Therapy

  • The primary goal of medical therapy is to reduce the risk of ipsilateral or contralateral breast invasion and also decreases the risk of recurrence.[3]

Surgery

  • Surgery is the mainstay of therapy for ductal carcinoma.[5]
  • Surgical approaches for ductal carcinoma, include: mastectomy or breast-conserving therapy
  • Lumpectomy in conjunction with adjuvant chemotherapy or radiation is the most common approach to the treatment of ductal carcinoma (with negative margins)
  • Mastectomy is recommended for patients with extensive margins of ductal carcinoma.

Prevention

  • Effective measures for the secondary prevention of ductal carcinoma include: screening mammography for women between 50-74 years (or earlier if identified risk factors) and periodical breast self-examination (BSE).[1][5]
  • Once diagnosed and successfully treated, patients with ductal carcinoma are followed-up every 3, 6, or 12 months depending on individual assessment.[5]

References

  1. ↑ 1.0 1.1 US Task Preventive Force. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening Accessed on April 19, 2016
  2. ↑ MacCarty WC. The histogenesis of cancer (carcinoma) of the breast and its clinical significance. Surg Gynecol Obstet 1913;17:441–59.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Virnig BA, Tuttle TM, Shamliyan T, Kane RL (2010). "Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes". J. Natl. Cancer Inst. 102 (3): 170–8. doi:10.1093/jnci/djp482. PMID 20071685.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Erbas B, Provenzano E, Armes J, Gertig D (2006). "The natural history of ductal carcinoma in situ of the breast: a review". Breast Cancer Res. Treat. 97 (2): 135–44. doi:10.1007/s10549-005-9101-z. PMID 16319971.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Ductal Carcinoma. Frank Galliard. Radiopedia http://radiopaedia.org/articles/ductal-carcinoma-in-situ Accessed on April 19, 2016


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