Резюме
Определение
Breast cancer comprises DCIS and LCIS (classic, pleomorphic, florid).
DCIS is a noninvasive breast cancer that is confined to the duct in which it originated and does not extend beyond the basement membrane.[1] The cancer does not have access to distant spread through lymphatics or the bloodstream. DCIS is a potential precursor of invasive carcinoma; risk of invasive breast cancer in women with DCIS is higher than in the general population.[2][3][4][Figure caption and citation for the preceding image starts]: Ductal carcinoma in situFrom the private collection of Dr Sauter; used with permission [Citation ends].
LCIS develops in breast lobule(s) and/or terminal ducts and is usually found incidentally. LCIS is not cancer but a pathologic description of a neoplastic proliferation of cells within lobules and/or terminal ducts, which is a risk factor for invasive breast cancer.[5] A finding of LCIS does not imply that cancer will form at the site where it is found. Treatment for LCIS is less formalized than for DCIS.[Figure caption and citation for the preceding image starts]: Lobular carcinoma in situFrom the private collection of Dr Sauter; used with permission [Citation ends].
Анамнез и осмотр
Ключевые диагностические факторы
- family history of breast cancer
Другие диагностические факторы
- nipple discharge
- breast lump
- eczema-like rash on nipple
- ulceration
Факторы риска
- family history of breast cancer
- benign breast disease on prior biopsy
- hereditary breast and ovarian cancer syndrome (HBOC)
- Li-Fraumeni syndrome
- Cowden syndrome
- hereditary diffuse gastric cancer (HDGC)
- Peutz-Jeghers syndrome
- Klinefelter syndrome
- older age at menopause
- older age at first full-term pregnancy
- nulliparity
- low physical activity
- high vitamin A intake
- ataxia telangiectasia
Диагностические исследования
Исследования, которые показаны в первую очередь
- mammography
Tests to avoid
- positron emission tomography (PET), computed tomography (CT), or radionuclide bone scans
Исследования, проведение которых нужно рассмотреть
- core needle biopsy
- excisional biopsy
- sentinel lymph node biopsy (SLNB)
- breast magnetic resonance imaging (MRI)
- breast ultrasound
- hormone receptor testing
- genetic evaluation
Алгоритм лечения
women with low-risk ductal carcinoma in situ (DCIS)
women with high-risk DCIS; all men with DCIS
lobular carcinoma in situ (LCIS)
local recurrence of DCIS
Составители
Авторы
Edward R. Sauter, MD, PhD
Medical Officer
Breast and Gynecologic Cancer Working Group
Division of Cancer Prevention
National Cancer Institute
Bethesda
MD
Раскрытие информации
ERS is an author of a reference cited in this topic.
Выражение благодарностей
Dr Edward R. Sauter would like to gratefully acknowledge Dr Rachel L. Ruhlen, a previous contributor to this topic.
Раскрытие информации
RLR declares that she has no competing interests.
Рецензенты
Carla Boetes, MD, PhD
Radiologist
Radboud University Nijmegen Medical Centre
Nijmegen
The Netherlands
Раскрытие информации
CB is an author of a number of references cited in this topic.
Alessandra Balduzzi, MD
Assistant in the Division of Medical Oncology
European Institute of Oncology
Milan
Italy
Раскрытие информации
AB declares that she has no competing interests.
Kala Visvanathan, MBBS, FRACP, MHS
Associate Professor in Epidemiology and Medical Oncology
Johns Hopkins School of Medicine and Bloomberg School of Public Health
Baltimore
MD
Раскрытие информации
KV is an author of a number of references cited in this topic.
Glyn T. Neades, MB ChB, FRCS(Glas), FRCS(Ed), ChM
Consultant Surgeon and Honorary Senior Lecturer
Edinburgh Breast Unit
Western General Hospital
Edinburgh
UK
Раскрытие информации
GTN is a principal investigator for the IBIS-II trial, and is an author of a guideline cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer risk reduction [internet publication].Полный текст
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer [internet publication].Полный текст
Loibl S, André F, Bachelot T, et al. Early breast cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024 Feb;35(2):159-82.Полный текст
Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol. 2016 Nov 20;34(33):4040-6. [Reaffirmed 2019.]Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Invasive breast cancer
- Atypical hyperplasia
- Fibroadenoma
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