Breast cancer in situ

Breast cancer in situ comprises ductal carcinoma in situ (DCIS), a non-invasive breast cancer that is confined to the duct in which it originates, and lobular carcinoma in situ (LCIS). There are three subtypes of LCIS: classical (which acts clinically as a neoplastic proliferation of cells that is a risk factor for invasive breast cancer), pleomorphic, and florid.

Typically asymptomatic and diagnosed at screening.

The UK NHS Breast Screening Programme offers routine mammographic screening every 3 years to all women from age 50 years. The UK National Institute for Health and Care Excellence recommends annual mammogram screening from age 40 years in women at moderate risk of breast cancer. The European Society for Medical Oncology recommends annual or biennial mammogram screening in all women from age 50 years. US guidelines typically recommend offering regular (annual or biennial) bilateral mammography screening to average-risk women starting at age 40 years.

Diagnosis is with mammography, supplemented with other imaging, such as ultrasound or magnetic resonance imaging, and biopsy.

Treatment of low-risk DCIS is usually lumpectomy (breast-conserving surgery) followed by radiotherapy. Pleomorphic and florid LCIS should be managed like DCIS. Classical LCIS is often managed conservatively.

Chemoprophylaxis (e.g., with tamoxifen, raloxifene, or an aromatase inhibitor [anastrozole or exemestane]) can be used in high-risk patients. Some high-risk patients may choose to undergo preventive bilateral total mastectomy.

Breast cancer in situ is a non-invasive breast cancer that is confined to the duct or lobule in which it originated and does not extend beyond the basement membrane. The cancer does not have access to distant spread through lymphatics or the bloodstream. Ductal carcinoma in situ (DCIS) is a potential precursor of invasive carcinoma and suggests that cancer will become invasive at that site.​[1]Hieken TJ, Cheregi J, Farolan M, et al. Predicting relapse in ductal carcinoma in situ patients: an analysis of biologic markers with long-term follow-up. Am J Surg. 2007 Oct;194(4):504-6. http://www.ncbi.nlm.nih.gov/pubmed/17826066?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Ductal carcinoma in situFrom the private collection of Dr Sauter; used with permission [Citation ends].

Lobular carcinoma in situ (LCIS) develops in breast lobule(s) and/or terminal ducts and is usually found incidentally. Whereas DCIS predicts an increased risk of invasive ductal carcinoma developing at the site of a biopsy demonstrating DCIS, LCIS implies increased risk of invasive ductal or lobular carcinoma developing in either breast.[2]Cocquyt V, Van Belle S. Lobular carcinoma in situ and invasive lobular cancer of the breast. Curr Opin Obstet Gynecol. 2005 Feb;17(1):55-60. http://www.ncbi.nlm.nih.gov/pubmed/15711412?tool=bestpractice.com ​ LCIS is not cancer but a pathological description of a neoplastic proliferation of cells within lobules and/or terminal ducts, which is a risk factor for invasive breast cancer.[3]Ginter PS, D'Alfonso TM. Current concepts in diagnosis, molecular features, and management of lobular carcinoma in situ of the breast with a discussion of morphologic variants. Arch Pathol Lab Med. 2017 Dec;141(12):1668-78. https://meridian.allenpress.com/aplm/article/141/12/1668/65743/Current-Concepts-in-Diagnosis-Molecular-Features http://www.ncbi.nlm.nih.gov/pubmed/28574280?tool=bestpractice.com A finding of LCIS does not imply that cancer will form at the diagnostic site. Consequently, treatment for LCIS is less formalised 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].