Li Christopher I, Malone Kathleen E, Saltzman Babette S, Daling Janet R
Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Epidemiology Program, Seattle, Washington, USA.
Cancer. 2006 May 15;106(10):2104-12. doi: 10.1002/cncr.21864.
Incidence rates of ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) have been rising, but little is known about which patients will develop invasive breast cancer or what types of tumors these patients may develop.
By using Surveillance, Epidemiology and End Results (SEER) data, the authors evaluated how types of invasive breast cancers diagnosed among 37,692 DCIS and 4490 LCIS patients differed and how clinical characteristics influenced subsequent breast cancer risk.
Among DCIS patients, incidence rates of ipsilateral and contralateral invasive breast cancer were 5.4/1000 person-years and 4.5/1000 person-years, respectively; and among LCIS patients, incidence rates were 7.3/1000 person-years and 5.2/1000 person-years, respectively. LCIS patients were 5.3-fold more likely than DCIS patients to develop invasive lobular carcinomas. Women whose DCIS had comedo histologic features or was poorly differentiated had 1.4-fold and 2.0-fold elevations in ipsilateral invasive breast cancer risk. Furthermore, among DCIS patients, 20-49 year-olds and black women and Hispanic white women had 1.6, 2.7, and 2.3-fold elevated risks of Stage III/IV breast cancer compared with 50-59 year-olds and non-Hispanic whites, respectively.
Screening young DCIS patients more frequently and improving the follow-up care of blacks and Hispanic whites with DCIS may reduce their risk of advanced-stage breast cancer. In addition, LCIS may be a precursor rather than just an ambiguous risk factor for invasive breast cancer, and, therefore, localized treatment for LCIS may be warranted. Given that incidence rates of DCIS and LCIS have been rising, investigations of these tumors should be continued to better understand their etiology and appropriate clinical management.
导管原位癌（DCIS）和小叶原位癌（LCIS）的发病率一直在上升，但对于哪些患者会发展为浸润性乳腺癌或这些患者可能发展为何种类型的肿瘤知之甚少。
作者利用监测、流行病学和最终结果（SEER）数据，评估了37692例DCIS患者和4490例LCIS患者中诊断出的浸润性乳腺癌类型的差异，以及临床特征如何影响后续患乳腺癌的风险。
在DCIS患者中，同侧和对侧浸润性乳腺癌的发病率分别为5.4/1000人年和4.5/1000人年；在LCIS患者中，发病率分别为7.3/1000人年和5.2/1000人年。LCIS患者发展为浸润性小叶癌的可能性是DCIS患者的5.3倍。DCIS具有粉刺组织学特征或分化差的女性，同侧浸润性乳腺癌风险分别升高1.4倍和2.0倍。此外，在DCIS患者中，20 - 49岁的女性、黑人女性和西班牙裔白人女性与50 - 59岁的女性和非西班牙裔白人相比，III/IV期乳腺癌风险分别升高1.6倍、2.7倍和2.3倍。
更频繁地筛查年轻DCIS患者，改善DCIS黑人患者和西班牙裔白人患者的后续护理，可能会降低他们患晚期乳腺癌的风险。此外，LCIS可能是浸润性乳腺癌的前驱病变，而不仅仅是一个模糊的风险因素，因此，对LCIS进行局部治疗可能是必要的。鉴于DCIS和LCIS的发病率一直在上升，应继续对这些肿瘤进行研究，以更好地了解其病因和适当的临床管理。
