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Ductal carcinoma in situ of the breast in Singapore: Recent trends and clinical implications
Author(s) -
Tan KongBing,
Lee HuiYin,
Putti Thomas Choudary
Publication year - 2002
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1046/j.1445-2197.2002.02550.x
Subject(s) - medicine , ductal carcinoma , breast cancer , pathological , progesterone receptor , incidence (geometry) , immunohistochemistry , breast surgery , mammography , gynecology , oncology , cancer , pathology , estrogen receptor , physics , optics
Background: Breast ductal carcinoma in‐situ (DCIS) is increasingly being diagnosed as a result of screening mammography and better pathological recognition. With this and the rising breast cancer incidence in Singapore, DCIS is poised to become a bigger part of surgical practice. Principles of screening, diagnosis and management of DCIS have also been rapidly evolving. Against this background, a clinicopathological audit of recent cases of DCIS in our centre was performed. Methods: Thirty‐eight cases of DCIS diagnosed in the period 1997−2000 were retrospectively analysed. Histological examination and immunohistochemical studies for oestrogen and progesterone receptor expression were performed. Results: In the present study, DCIS was most common in the group of patients who were <50 years (58%) as compared to an American series’ where the corresponding group were ≥60 years (36%). Compared to a previous local study a decade ago, the present series showed that: (i) DCIS constituted a higher proportion of all breast cancers (6.4% vs 3.7%); (ii) a larger proportion of patients had disease detected by mammography (47% vs 10%); (iii) conservative breast excision was the only definitive surgery in 39% of cases ( vs approximately 30%); and (iv) the mean size of lesions is smaller (13.5 mm vs 24.4 mm). Histologically, 26% of tumours were high grade, 71% had necrosis while 32% were oestrogen receptor (ER) and progesterone receptor (PR) negative. High grade tumours were associated with the presence of necrosis ( P = 0.018), ER negativity ( P = 0.015) and PR negativity ( P = 0.001). Conclusions: This study reveals interesting trends of DCIS in Singapore. The sizeable proportion of hormone receptor‐negative tumours may have implications for the hormonal adjuvant therapy of DCIS.