Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ

Elshof, Lotte E.; Schmidt, Marjanka K.; Rutgers, Emiel J.; Leeuwen, Flora E. van; Wesseling, Jelle; Schaapveld, Michael

doi:10.1097/sla.0000000000002239

Cited by 64 publications

(73 citation statements)

References 28 publications

(37 reference statements)

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“…These new data were also compared with data from other large studies performed in several countries, especially The Netherlands, the United Kingdom (UK), Canada, and the United States (US). 2,9,10,[12][13][14][15][16] The overall rate of mammographically detected DCIS in both surveys was identical: 87.5%, in accordance with other series. 17 Microcalcifications remain the major abnormality (87% vs. 82.5% previously).…”

Section: Discussionsupporting

confidence: 88%

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Cutuli

Lemanski

Lafontan

et al. 2020

Clinical Breast Cancer

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This was an analysis of 2125 ductal carcinoma in situ features/treatments from 71 French centers. Mastectomy and breast-conserving surgery was performed in 25% and 75% of cases, respectively; the median tumor size was 15 mm, and the low, intermediate, and high nuclear grade distribution was 12%, 36%, and 47%, respectively. After breast-conserving surgery, 97% underwent whole breast irradiation. This survey reflects the daily ductal carcinoma in situ treatment in France, and the results are in accordance with national guidelines. Background: Ductal carcinoma in situ (DCIS) represents 15% of all breast cancers in France. The first national survey was conducted in 2003. The present multi-center real-life practice survey aimed at assessing possible changes in demographic, clinical, pathologic, and treatment features. Material and Methods: From March 2014 to September 2015, patients diagnosed with DCIS from 71 centers with complete information about age, diagnostic features, and treatment modalities were prospectively included. Results: A total of 2125 patients with a median age of 58.6 years from 71 centers were studied. DCIS was diagnosed by mammography in 87.5% of cases. Preoperative biopsy was performed in 96% of cases. The median tumor size was 15 mm. Nuclear grade was low, intermediate, and high in 12%, 36%, and 47% of cases, respectively. Margins were considered to be negative in 83% of cases. Overall mastectomy and lumpectomy rates were 25% and 75%, respectively. The immediate breast reconstruction rate was 50%. Sentinel node biopsy and axillary dissection rates were 41% and 2.6%, respectively. After lumpectomy, 97% of patients underwent radiotherapy, and 32% received a boost dose. Only 1% of patients received endocrine therapy. Compared with our previous survey, the median tumor size remained the same, and the proportion of high-grade lesions increased by 9%. The mastectomy rate decreased by 4%. Conclusions: The clinical practice identified in this survey complies with French DCIS guidelines. About 10% of patients with low-grade DCIS may be eligible to participate in treatment de-escalation trials.

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Section: Discussionsupporting

confidence: 88%

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Cutuli

Lemanski

Lafontan

et al. 2020

Clinical Breast Cancer

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“…Many population-based studies examining the various treatments in patients with DCIS have confirmed a reduction in local recurrences with local therapies (mastectomy vs lumpectomy and lumpectomy plus radiotherapy vs lumpectomy alone) 4,5,6,15 ; however, most have reported no significant difference in breast cancer mortality. 4,5,6,7,8,15,16 …”

Section: Discussionmentioning

confidence: 99%

Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy

2018

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Key Points Question Is adjuvant radiation associated with a reduction in breast cancer mortality in patients treated for ductal carcinoma in situ? Findings Using a matched approach in a large cohort of patients treated for ductal carcinoma in situ, treatment with lumpectomy and radiotherapy was associated with a significantly reduced risk of breast cancer–specific mortality compared with treatment with lumpectomy alone (hazard ratio, 0.77; 95% CI, 0.67-0.88) or mastectomy alone (hazard ratio, 0.75; 95% CI, 0.65-0.87). Meaning Adjuvant radiation is associated with a small but significant breast cancer survival benefit in patients with ductal carcinoma in situ that cannot be accounted for by enhancing local control.

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“…Women aged less than 50 years old have been shown to present with more aggressive tumors [41], yet there was no significant difference in tumor characteristics by age group (Table 1). It is known that DCIS with invasive micro infiltrations clinically unrecognizable are common among young women [17]. Invasive infiltrations are considered an important risk factor of death after DCIS diagnosis [42].…”

Section: Mortalitymentioning

confidence: 99%

“…Competing causes of death and all-cause mortality would allow to overcome these limitations. Few studies have compared all-cause mortality rates of women with DCIS to the general population, most of which are in northern Europe [14][15][16][17] and the US [18]. Considering the possible differences in prevention plans, detection and treatment approaches between countries [19][20][21][22], it becomes relevant to provide evidence on all-cause mortality for patients diagnosed with a DCIS in regions where is not yet available, such as Southern Europe.…”

Section: Introductionmentioning

confidence: 99%

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

et al. 2018

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Purpose We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994 and to estimate the all-cause mortality excess risk of diagnosed women. Methods Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). Results Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). Conclusions Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

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Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ

Abstract: Supplemental Digital Content is available in the text

Cited by 64 publications

References 28 publications

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

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