title: The frequency of presentation and clinico-pathological characteristics of symptomatic versus screen detected ductal carcinoma in situ of the breast.
abstract: BACKGROUND
  DCIS accounts for 20% of screen-detected breast cancers, but also presents symptomatically. Historically, approximately 5% of DCIS was thought to be symptomatic, but accurate evaluation of the presentation of symptomatic DCIS is needed to determine its incidence and tumour biology.
  
  
  METHODS
  Clinico-pathological details of a consecutive series of patients presenting to a single breast-unit, with a pre-operative diagnosis of DCIS, were selected. Data included age, mode of presentation, pre-operative clinical and radiographical findings. The final tumour histology, operation, size, grade, ER status (and HER2 expression in invasive cases) were recorded.
  
  
  RESULTS
  375 patients had a pre-operative histological diagnosis of DCIS. 308 (82%) screen-detected (median age 59), 67 (18%) presented via symptomatic clinics (median age 50). At final histology 286 (74%) were pure DCIS, and 67 (23%) had an invasive focus. 43% (29/67) of symptomatic cases had an invasive focus at final histology versus 19% (60/308) screen-detected (p ≤ 0.001). 31% (9/29) of symptomatic, versus 10% (6/60) of screen-detected cases with invasion were node positive (p = 0.05). 45% (28/62) intermediate/high-grade symptomatic cases had an invasive focus at final histology, compared to 19% (57/297) intermediate/high-grade screen-detected cases. 86% (212/248) screen-detected pure DCIS was ER positive compared to 68% (26/38) symptomatically presenting pure DCIS (p ≤ 0.001). Overall, 13% (38/248) pure DCIS presented symptomatically (p = 0.001).
  
  
  CONCLUSIONS
  Overall, thirteen percent of pure DCIS present symptomatically. Nearly half of symptomatically presenting DCIS at core biopsy has an occult invasive focus and is more frequently ER negative. Symptomatic DCIS with an invasive focus is more likely to have lymph node involvement.
authors.affiliation: Academic Department of Breast Surgery, University Hospital of South Manchester, 2nd Floor, Education and Research Centre, Southmoor Road, Manchester M23 9LT, UK. Electronic address: nicolabarnes@doctors.org.uk.
authors.forename: N L P
authors.initials: NL
authors.lastname: Barnes
authors.affiliation: Academic Department of Breast Surgery, University Hospital of South Manchester, 2nd Floor, Education and Research Centre, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dimopoulos
authors.affiliation: Academic Department of Breast Surgery, University Hospital of South Manchester, 2nd Floor, Education and Research Centre, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Williams
authors.affiliation: Department of Histopathology, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Howe
authors.affiliation: Academic Department of Breast Surgery, University Hospital of South Manchester, 2nd Floor, Education and Research Centre, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Bundred
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: Breast; Cancer; DCIS; In situ; Screening; Symptomatic