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September 18, 1996

Detection and Treatment of Ductal Carcinoma In Situ of the Breast

Author Affiliations

Brooke Army Medical Center Fort Sam Houston, Tex

JAMA. 1996;276(11):870. doi:10.1001/jama.1996.03540110024016

To the Editor.  —Dr Ernster and colleagues1 have shown that the increase in the incidence of DCIS coincides with the widespread adoption of mammographic screening. In another study,2 women aged 20 to 54 years who were victims of unintentional injury or violence were found at autopsy to have a prevalence of DCIS that was 4 to 5 times greater than the number of overt breast cancers expected to develop clinically over 20 years. These studies suggest that the increase in incidence of DCIS is due to mammographic screening, but that not all DCIS detected mammographically will progress to invasive breast cancer. Yet, for purposes of obtaining insurance, loans, and employment, women with mammographically detected DCIS face the same challenges that confront patients with invasive cancer.3 These include the outright refusal of insurance coverage, being able to obtain only coverage with inflated premiums, the offer of only high-risk types of insurance