Ductal carcinoma-in-situ of the breast with subsequent distant metastasis and death

Ann Surg Oncol. 2011 Oct;18(10):2873-8. doi: 10.1245/s10434-011-1707-2. Epub 2011 Apr 8.


Background: The rare patient diagnosed with pure ductal carcinoma-in-situ (DCIS) develops distant breast cancer metastases (DM). We sought to identify clinical and pathologic predictors of DM.

Methods: The clinical and pathologic characteristics of patients with DM after a diagnosis of pure DCIS from 1996 to 2009 were analyzed.

Results: Twenty five patients with DM after an initial diagnosis of DCIS were identified; 3 were treated at our institution and 22 were originally treated elsewhere. The rate of DM was 0.14% among 2,123 patients originally treated at our institution. Among all patients with DM, 73.7% had DCIS with necrosis, and 62% had DCIS that did not express estrogen receptor. Twenty-four percent of patients with DM were African American, compared to 11.5% of the total study population. The median time from DCIS to DM was 4.5 years. Sixteen patients (66%) had a preceding or simultaneous invasive locoregional recurrence (LRR); nine (34%) did not. At last follow-up, 14 patients (56%) had died of disease; median time to death was 2.4 years. No dominant variables could be identified in patients who developed DM with or without a LRR.

Conclusions: DM after a diagnosis of pure DCIS is rare. Although most patients with DM have a preceding invasive LRR, some present with subsequent DM alone. Further study is required to identify clinical and pathologic predictors of this more rapid disease progression.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Bone Neoplasms / mortality
  • Bone Neoplasms / secondary*
  • Bone Neoplasms / surgery
  • Breast Neoplasms / mortality*
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Carcinoma, Ductal, Breast / mortality
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Ductal, Breast / surgery
  • Carcinoma, Intraductal, Noninfiltrating / mortality*
  • Carcinoma, Intraductal, Noninfiltrating / pathology*
  • Carcinoma, Intraductal, Noninfiltrating / surgery
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Prognosis
  • Skin Neoplasms / mortality
  • Skin Neoplasms / secondary*
  • Skin Neoplasms / surgery
  • Survival Rate