From the Guidelines
The most common presentation of ductal carcinoma in situ is microcalcification, which corresponds to option (d). DCIS is typically asymptomatic and is most frequently detected through mammographic screening rather than through clinical symptoms. Microcalcifications appear as tiny calcium deposits on mammograms and often represent the earliest detectable sign of DCIS, as reported by 1. Unlike invasive breast cancer, DCIS rarely presents with palpable lumps (option b) because it remains confined within the breast ducts without invading surrounding tissue. Breast pain (option a) is an uncommon presentation for DCIS and is more often associated with benign conditions. While nipple discharge (option c) can occasionally occur with DCIS, particularly if it involves ducts near the nipple, it is not the most common presentation. The identification of microcalcifications on routine mammography has significantly improved early detection of DCIS, allowing for treatment before progression to invasive disease, as also noted in 1. Key points to consider include:
- Microcalcifications are the most common mammographic presentation of DCIS, found in 90-98% of cases 1
- DCIS is typically asymptomatic and detected through screening
- Early detection through mammography improves treatment outcomes by allowing for intervention before progression to invasive disease.
From the Research
Presentation of Ductal Carcinoma In Situ
- The most common presentation of ductal carcinoma in situ (DCIS) is as a cluster of microcalcifications on a mammogram 2, 3, 4.
- Microcalcifications associated with DCIS can appear as linear, branching, or granular microcalcifications on a mammogram, and are often unicentric and segmental in distribution 2.
- The presence of microcalcifications is a key factor in the diagnosis of DCIS, and stereotactic vacuum-assisted breast biopsy is a reliable method for diagnosing DCIS in patients with suspicious microcalcifications 3, 5.
- While breast pain, breast lump, and nipple discharge can be symptoms of breast cancer, they are not the most common presentation of DCIS 4.
- The correct answer is (d) microcalcification, as it is the most common presentation of DCIS, and is often detected by mammography 2, 3, 4.