Isolated ductal carcinoma in situ in patients presenting to two breast units in Johannesburg

Keywords: isolated ductal carcinoma, ductal carcinoma in situ

Abstract

Background: Ductal carcinoma in situ (DCIS) represents approximately 20% of all new breast cancers in countries with population-based mammography screening. South Africa is an upper middle-income country with no such screening programmes in place, and the proportion of isolated DCIS appears much lower than this. Most patients present with symptomatic disease and high-risk features. There are numerous controversies regarding the diagnosis and optimal management strategy for this premalignant condition, and the issue of overtreatment is much debated. Our study aimed to determine the proportion of patients presenting with isolated DCIS, to describe the clinical presentation and to describe the treatment provided.

Methods: This is a retrospective cohort study of patients with histologically confirmed isolated DCIS at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital from July 2015 to March 2018. Records were collected from the existing clinical databases in both breast units and from the South African National Health Laboratory System.

Results: Out of 1 813 patients diagnosed and managed with breast  malignancies in this period, 58 (3.1%) patients were identified with isolated DCIS. Forty-three (74.1%) of these patients were symptomatic. Thirty-four (58.6%) patients had a primary mastectomy, and 12 (20.6%) had breast-conserving surgery.

Conclusion: The diagnosis of isolated DCIS is rare in our setting, and the majority of patients present with more advanced, symptomatic disease that is not deemed suitable for breast-conserving surgery. The short-term follow-up of our patients has shown a low rate of recurrence and mortality thus far. However, further long-term follow-up is needed.

Author Biographies

L J Thornley, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, South Africa

S Nietz, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, South Africa

H Cubasch, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand and Breast Unit, Chris Hani Baragwanath Academic Hospital, South Africa

Published
2022-06-28
How to Cite
Thornley, L., Nietz, S., & Cubasch, H. (2022). Isolated ductal carcinoma in situ in patients presenting to two breast units in Johannesburg. South African Journal of Surgery, 60(2), 103-108. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3626
Section
Breast Surgery