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Journal of the National Cancer Institute Advance Access published online on February 12, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn013
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Published by Oxford University Press 2008.

EDITORIALS

The Sea of Uncertainty Surrounding Ductal Carcinoma In Situ—The Price of Screening Mammography

H. Gilbert Welch, Steven Woloshin, Lisa M. Schwartz

Affiliations of authors: Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT (HGW, SW, LMS); Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (HGW, SW, LMS); Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH (HGW, SW, LMS)

Correspondence to: H. Gilbert Welch, MD, MPH, Veterans Affairs Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009 (e-mail: h.gilbert.welch@dartmouth.edu).

The first 10% of the full text of this article appears below.

Wouldn’t it be easier if we lived in a binary world? Everything would be either black or white, yes or no, 1 or 0. And biopsy results would be either normal or cancer.

Unfortunately, in the world of cancer, our efforts to detect the disease early have made this a fantasy. We are increasingly faced with the reality of a big gray zone—a broad spectrum of pathologic findings between normal tissue and invasive cancer. And our nosology reflects the associated ambiguity—dysplasia, intraepithelial neoplasia, hyperplasia with atypia, and even abnormalities of "unknown significance." The unifying theme for these findings is that they may progress to invasive cancer. Or they may not.

Despite the presence of the word "carcinoma," ductal carcinoma in situ (DCIS) is the poster child for this problem (a senior pathologist involved in developing classification systems confided to one of us that he regretted the . . . [Full Text of this Article]


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