Contents

Search

ductal carcinoma, breast

See breast cancer. Epidemiology: most frequent histologic type (70%) Genetics: - see breast cancer - overexpression of NEK8 - specifically implicated genes: - KAT, KIAA0100, BCL9L, TP73, CTNND1, TNK2 Laboratory: - if hormone receptor-positive, HER2-negative breast cancer with < 4 positive axillary nodes, multigene recurrence assay indicated to guide adjuvant chemotherapy decisions [1] - Oncotype DX, MammaPrint, EndoPredict, or Prosigna - PD-L1 can be used to determine which patients with advanced triple-negative breast cancer may benefit from immunotherapy - has not been shown to predict the benefit of immunotherapy for patients with early-stage breast cancer Radiology: - PET scan not indicated in asymptomatic women (see breast cancer) Management: 1) ductal carcinoma in situ a) surgical excision with negative margins by histopathology b) adjuvant radiation therapy cuts recurrence rate in half c) adjuvant aromatase inhibitor for postmenopausal women [1] d) adjuvant tamoxifen for 5 years for premenopausal women [1] e) axillary node dissection is not indicated - incidence of lymph node metastases is 2-3% 2) invasive ductal carcinoma a) modified radical mastectomy (most common surgery) b) breast-conserving therapy 1] lumpectomy 2] partial (segmental) mastectomy or quadrantectomy 3] radiation therapy c) sentinel lymph node biopsy - if hormone receptor-positive, HER2-negative breast cancer with < 4 positive axillary nodes, multigene recurrence assay indicated to guide adjuvant chemotherapy decisions - Oncotype DX, MammaPrint, EndoPredict, or Prosigna - selected patients (determined from multigene recurrence assay) benefit from adjuvant chemotherapy initiated 4-8 weeks after surgery, followed by radiation therapy (if applicable) [1] & then endocrine therapy. d) tamoxifen vs aromatase inhibitor for estrogen receptor-positive tumor after lumpectomy & radiation therapy to reduce risk of local recurrence &/or 2nd primary 3) if HER2 positive, see HER2 positive breast cancer

Interactions

disease interactions

Specific

tubular carcinoma of the breast

General

breast cancer ductal adenocarcinoma

Database Correlations

OMIM correlations

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 666
  3. Smith BD et al, Effectiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst 2006, 98:1302 PMID: 16985249
  4. Fisher B, Dignam J, Wolmark N et al Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999 Jun 12;353(9169):1993-2000. PMID: 10376613