13 years later, after transition from DCIS to metastatic disease, the patient had acquired additional mutations in TP53 (G279E homozygous), PTEN (L302fs and N329fs), MAP2K4 (G183fs homozygous), and TGFBR2 (G68S). This evidence concerns the gene TGFBR2 and ductal breast carcinoma in situ.