DCIS in Male and Aged Women with Comorbidities

The incidence rates of ductal carcinoma in situ (DCIS) have increased rapidly over the last two decades in all patient groups including older women and men. DCIS in aged women has an excellent prognosis and the risk of local recurrence is lower compared to younger patients. Since adjuvant radiation after lumpectomy and endocrine treatment do not significantly influence overall survival a de-escalation of treatment especially in case of grade 1 lesions in women with comorbidities can be considered. Pure DCIS in men is a very rare disease representing approximately 5% of all male breast cancers. The most common type of DCIS in men is a papillary carcinoma mostly of low or intermediate grade developing from large central ducts, since male breast typically lacks lobules and terminal duct-lobular units (TDLU). A male DCIS of high grade is rare and mostly associated with severe hyperestrogenism, e.g., in case of gynecomastia. The most common risk factors in men are increasing age, high estrogen levels and positive family history. DCIS in men is usually a clinically apparent disease. The most common symptoms described in the literature are palpable, often cystic mass, coexisting or isolated nipple discharge (mostly bloody, in rare cases watery) or nipple alteration. A standard treatment among men with DCIS is a simple mastectomy without radiation. The prognosis is excellent.