Prognosis

Recurrence

Ductal carcinoma in situ (DCIS) can recur if inadequately treated or if unknown disease is present in the area treated or in other areas of the breast.

Mastectomy carries the lowest risk of disease recurrence, approximately 2%. Large tumour size, high histological grade, also suggested by the presence of comedo-necrosis, and high expression of nuclear protein p16 are associated with increased recurrence risk.[123] Positive or close resection margin and lack of radiotherapy also increase risk of recurrence. Oestrogen and progesterone status do not affect recurrence risk, while HER2/neu expression is predictive of recurrence.

Other factors that are associated with a higher risk of invasive disease after a diagnosis of DCIS include age under 60 years, premenopausal status, African-American race, and detection by palpation.[123] Lobular carcinoma in situ (LCIS) is not cancer so much as an indicator of increased risk, so survival rates are not pertinent. The 5-year survival from DCIS is 98%.[124]

Despite competing causes of death, breast cancer is the cause of death in many older women, with up to 40% of women over 80 years old dying from breast cancer.[125]

Recurrence of DCIS in males is unacceptably high after breast-conservation therapy without postoperative radiation. Breast conservation with radiation also is not generally recommended.[126]

Studies and initiatives are ongoing to identify patients with low-risk DCIS for whom adjuvant radiation may confer little benefit or potentially constitute over-treatment.[83][84]

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