Ductal carcinoma in situ is presumably not a metastatic disease: a reply to “Commentary: Wherein the authors attempt to minimize the confusion generated by their study ‘Breast cancer mortality after a diagnosis of ductal carcinoma in situ’ by several commentators who disagree with them and a few who don’t: a qualitative study”

Letter to the Editor

Ductal carcinoma in situ is presumably not a metastatic disease: a reply to “Commentary: Wherein the authors attempt to minimize the confusion generated by their study ‘Breast cancer mortality after a diagnosis of ductal carcinoma in situ’ by several commentators who disagree with them and a few who don’t: a qualitative study”


Brett T. Snodgrass, MD



doi: http://dx.doi.org/10.3747/co.25.3881

The Editor

Current Oncology

11 September 2017

Ductal carcinoma in situ (dcis) is presumably not a metastatic disease1. Missed invasive cancer was proposed2 as an explanation for the finding of Narod et al.3 of mortality due to breast cancer after the excision of dcis and without the occurrence of invasive breast cancer in either breast. However, Narod replied that the concept of “missed invasive cancer” was without evidence4.

The original authors continue to advocate5 that their retrospective database study3 contains data of sufficient quality to suggest that dcis is a metastatic disease. However, the pathology literature provides evidence that invasive cancer has been missed6. A missed diagnosis of invasive breast cancer and subsequent reporting as dcis would account for the findings of Narod et al.3 while concomitantly reflecting the known limitations of tissue sampling for histopathologic analysis6.

CONFLICT OF INTEREST DISCLOSURES

I have read and understood Current Oncology’s policy on disclosing conflicts of interest, and I declare that I have none.

AUTHOR AFFILIATIONS

Center for Advanced Medicine and Research, Saint Peters, MO, U.S.A..

REFERENCES

1. van Dongen JA, Fentiman IS, Harris JR, et al. In-situ breast cancer: the eortc consensus meeting. Lancet 1989;2:25–7.
cross-ref  pubmed  

2. Snodgrass B. Treatment and long­term risks for patients with a diagnosis of ductal carcinoma in situ. JAMA Oncol 2016;2:399.
cross-ref  

3. Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol 2015;1:888–96.
cross-ref  pubmed  

4. Narod SA. Treatment and long­term risks for patients with a diagnosis of ductal carcinoma in situ—reply. JAMA Oncol 2016;2:400–1.
cross-ref  pubmed  

5. Narod SA, Ahmed H, Sopik V. Wherein the authors attempt to minimize the confusion generated by their study “Breast cancer mortality after a diagnosis of ductal carcinoma in situ” by several commentators who disagree with them and a few who don’t: a qualitative study. Curr Oncol 2017;24:e255–60.
cross-ref  

6. Wiley EL, Keh P. Diagnostic discrepancies in breast specimens subjected to gross reexamination. Am J Surg Pathol 1999;23:876–9.
cross-ref  pubmed  


Correspondence to: Brett T. Snodgrass, Center for Advanced Medicine and Research, 203–2730 South Saint Peters Parkway, Saint Peters, Missouri 63303 U.S.A. E-mail: drsnodgrass@camrusa.com

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Current Oncology, VOLUME 25, NUMBER 2, April 2018








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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)