Differences in the pathologic features of ductal carcinoma in situ of the breast based on patient age

BACKGROUND, Young patient age at diagnosis has been reported as a risk fact or for recurrence in patients with ductal carcinoma in situ (DCIS) of the b reast treated with breast-conserving therapy (BCT). The authors examined pa thologic features of DCIS in three different age groups of patients to iden tify differences that might explain why young patient age at the time of di agnosis is a risk factor for recurrence. METHODS. Excised specimens from 177 breasts of 172 patients with DCIS treat ed with BCT were studied. All slides from all specimens were reviewed. Pati ents were divided into 3 age groups: those age < 45 years, those ages 45-59 years, and those age greater than or equal to 60 years. The histologic fea tures that were quantified included most common and highest nuclear grades, DCIS architectural pattern, amount of central necrosis (quartiles), calcif ications, amount of DCIS, and number of terminal duct lobular units (TDLUs) with cancerization of lobules (COL) within 0.42 cm of the margin, margin s tatus, and size and volume of excision specimens. RESULTS, Patients age < 45 years at the time of diagnosis more frequently h ad higher nuclear grade DCIS (highest nuclear Grade 3: 69%, 60%, and 39%; P = 0.093), respectively and central necrosis (72%, 62%, and 44%; P = 0.01), respectively. Although not statistically significant, younger patients ten ded to have comedo subtype DCIS more often (31%, 23%, and 19%; P = 0.35), r espectively. Younger patients also more often had smaller initial biopsy sp ecimen maximum dimensions (4.3 cm, 5.2 cm, and 5.7 cm; P = 0.004), respecti vely, with close or positive margins (89%, 61%, and 64%; P = 0.03), and mor e TDLUs with COL in the 0.42-cm rim of tissue adjacent to the margin (5.2, 3.6, and 1.9; P = 0.23), respectively. No other features including the amou nt of DCIS when classified as > 50% or > 75% of ducts, calcifications withi n DCIS ducts, pattern of DCIS involvement, number of slides examined, numbe r of slides with DCIS, and mean number of DCIS ducts near the margin were f ound to occur more frequently in younger patients. CONCLUSIONS, Younger patients with DCIS may have an increased risk of local recurrence when treated with BCT due to smaller initial excision volumes, a greater proportion of high nuclear grade DCIS, and central necrosis. (C) 2000 American Cancer Society.