Prognosis for Ductal Carcinoma in Situ (DCIS) of the Breast

Ductal carcinoma in situ (DCIS) has an excellent prognosis with 10-year cause-specific survival rates of 96-100% when appropriately treated. 1

Overall Survival and Recurrence Rates

DCIS is a non-invasive precursor to invasive breast cancer with high survival rates when properly managed 2, 3
The 10-year cause-specific survival ranges from 96-100% following conservative surgery and radiation 1
Mastectomy is associated with a very low risk of chest wall recurrence (approximately 1%) 2
Conservative surgery with radiation shows 10-year breast tumor recurrence rates ranging from 6-23% 1
Conservative surgery alone has higher recurrence rates, with studies showing 15-year actuarial local recurrence rates of approximately 18% 1

Nuclear grade and comedo-type necrosis influence recurrence patterns 1
High-grade or comedo DCIS tends to recur earlier (median 3.1 years) compared to non-comedo DCIS (median 6.5 years) 1
The Van Nuys Prognostic Index, which incorporates tumor size, margin width, and pathologic classification, helps predict recurrence risk (scores range from 3-9, with lower scores indicating better prognosis) 1

Negative surgical margins significantly reduce recurrence risk 1
Patients with close or positive margins have a 29% crude breast tumor recurrence rate compared to 7% for those with negative margins 1
Wide surgical excision is associated with better outcomes in patients treated with conservative surgery and radiation 1

Approximately 85-90% of DCIS is now detected solely by mammography, usually characterized by microcalcifications 1
Mammographically detected DCIS generally has better outcomes than clinically evident DCIS (palpable mass or bloody nipple discharge) 1

About 50% of recurrences following conservative surgery and radiation are invasive cancers 1
Invasive recurrences typically appear later (around 5 years) than non-invasive recurrences (around 4 years) 1
Most recurrences occur near the primary tumor site 1
Nearly all patients with non-invasive recurrence can be salvaged with mastectomy 1
Approximately 75% of patients with invasive recurrence can be salvaged 1

Radiation therapy after lumpectomy significantly decreases recurrence rates 2
Tamoxifen may reduce the risk of invasive breast cancer in patients with DCIS (43% reduction in the NSABP B-24 trial) 4
The risk of second malignant neoplasms after breast conservation therapy for DCIS is similar to the general population risk of developing cancer (approximately 12% at 15 years) 5

Young age may be associated with higher recurrence rates in some studies, though evidence is mixed 1
Family history of breast cancer has shown conflicting associations with recurrence risk 1
IDC with coexisting DCIS has been associated with improved prognosis compared to pure IDC 6

Underestimating recurrence risk in low-grade DCIS due to its longer time to recurrence 1
Inadequate surgical margins significantly increase recurrence risk 1
Lack of proper mammographic and pathologic correlation may lead to suboptimal treatment decisions 1
Overtreatment with mastectomy in patients with small, well-excised, low-grade lesions who might be suitable for breast conservation 1, 2