title: Ductal carcinoma in situ of the breast in Singapore: recent trends and clinical implications.
abstract: 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 > or =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.
authors.affiliation: Department of Pathology, National University Hospital, National University of Singapore, Singapore. pattankb@nus.edu.sg
authors.forename: Kong-Bing
authors.initials: KB
authors.lastname: Tan
authors.forename: Hui-Yin
authors.initials: HY
authors.lastname: Lee
authors.forename: Thomas Choudary
authors.initials: TC
authors.lastname: Putti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged