Breast ductal carcinoma in situ in an unscreened population: presentation, diagnosis and management at a single tertiary centre.

BACKGROUND: To determine the clinical presentation of patients presenting with isolated ductal carcinoma in situ at a single tertiary center in the Cape Town, South Africa. To review the diagnostic techniques most commonly used and the primary surgery performed for these patients.

METHOD: We performed a retrospective folder review of patients diagnosed with DCIS over a period from Jan 2005 to Dec 2012, at the Combined Breast Cancer Clinic at Groote Schuur Hospital. Patients with a histological diagnosis of DCIS were identified from a prospectively collected patient database and the South African National Health Laboratory System (NHLS) histological reports and operative records.

RESULTS: 42 patients with isolated DCIS were identified. This represents 1.1% (42/3636 ) of all breast malignancies managed in this period. The average age of presentation was 58 years. Most patients presented with a breast lump (23/42). The diagnosis was made on core biopsy in 14 patients while 8 patients required excision of the palpable lump to make the diagnosis. 23 patients underwent a primary mastectomy, 6 patients had a wide local excision 8( WLE) and 6 patients had radio-guided occult lesion localization (ROLL) with therapeutic intent.

CONCLUSION: Though rare, the management of DCIS in this setting highlights the challenges of diagnosing and managing early breast malignancies in LMICs.