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Reply to the Baader–Meinhof phenomenon in ductal carcinoma in situ of the breast

presence of myxoid stroma and lymph node involvement. To our knowledge, no other studies on myxoid stroma in breast cancer have been reported yet. We previously observed that myxoid periductal stroma in DCIS was associated with an increased overall recurrence risk, and with an increased risk of invasive recurrence in particular. The presence of myxoid stroma was associated with reduced periductal decorin expression. Although these observations require validation on larger, independent patient cohorts, we hypothesize that this myxoid architecture might mirror an invasion-permissive microenvironment. We speculate that the normal breast stroma functions as a protective barrier against invasion, and that its remodelling is likely to enable invasion. Some preinvasive lesions are able to influence neighbouring fibroblasts in order to modulate the composition of their surrounding extracellular matrix. Future translational studies should aim at targeting these adverse stromal changes, in order to prevent or disrupt the process of cancer cell invasion. In summary, we noticed the regular appearance of several photographs of DCIS with myxoid periductal stroma in both original reports and review articles, after we described myxoid stromal changes in DCIS. In psychology, such a phenomenon is referred to as ‘selective attention bias’ or ‘frequency illusion’, which is better known as the ‘Baader–Meinhof phenomenon’ in popular literature. Remarkably, myxoid stroma is generally overlooked by authors who publish photographs of DCIS: myxoid stroma is often overtly present, but, as the authors had not yet learned about it, they did not perceive it. In a certain way, this is a kind of cognitive bias as well. We hope that this letter will lead to the acknowledgement of the existence and potential importance of myxoid stroma in DCIS by other researchers and experts in this field, including the authors of the aforementioned articles. Subsequently, this might stimulate researchers to include assessment of stromal features in future studies on DCIS, especially in large ongoing trials such as NSABP B-43, the LORD trial, and the LORIS trial. If such investigations lead to the validation of our findings regarding its prognostic value, myxoid stroma might become part of standard reporting on DCIS in daily histopathological practice.