Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery

Punglia, Rinaa S.; Jiang, Wei; Lipsitz, Stuart R.; Hughes, Melissa E.; Schnitt, Stuart J.; Hassett, Michael J.; Nekhlyudov, Larissa; Achacoso, Ninah; Edge, Stephen B.; Javid, Sara H.; Niland, Joyce C.; Theriault, Richard L.; Wong, Yu‐Ning; Habel, Laurel A.

doi:10.1007/s10549-017-4553-5

Cited by 14 publications

(14 citation statements)

References 34 publications

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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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“…Moreover, only a minority of DCIS patients will benefit from these findings, since only 9-12% of DCIS are low grade. 13,24,[40][41][42] Additional inclusion criteria besides nuclear grade will further decrease the number of eligible patients. The overall impact of active surveillance trials on the population of DCIS patients might therefore be limited.…”

Section: Is Active Surveillance a Noninferior Alternative?mentioning

confidence: 99%

“…Patient recruitment might be facilitated by including patients of previously conducted randomized clinical trials and retrospective studies, of which a nonexhaustive selection is summarized in Table 2. 17,19,20,24,41,70,[90][91][92][93][94][95][96][97] Inclusion of these patients in a study conducted according to the new research strategy would allow for correction of treatment effects, since a substantial number of patients are treated with radiotherapy and/or TAM after BCS. Additionally, it would be interesting to also include HER2-positive DCIS patients with recurrences from the currently ongoing NSABP B-43 trial, wherein the value of adjuvant trastuzumab is investigated.…”

Section: Practical Implementation Of the Alternative Research Strategymentioning

confidence: 99%

“…Even if these active surveillance trials prove that watchful waiting is not inferior compared to standard treatment, it will take many years before these data will be available for routine clinical use. Moreover, only a minority of DCIS patients will benefit from these findings, since only 9–12% of DCIS are low grade . Additional inclusion criteria besides nuclear grade will further decrease the number of eligible patients.…”

Section: Introductionmentioning

confidence: 99%

“…A multicenter approach seems therefore mandatory, to enable the inclusion of a sufficiently large number of DCIS patients with subsequent recurrence. Patient recruitment might be facilitated by including patients of previously conducted randomized clinical trials and retrospective studies, of which a nonexhaustive selection is summarized in Table . Inclusion of these patients in a study conducted according to the new research strategy would allow for correction of treatment effects, since a substantial number of patients are treated with radiotherapy and/or TAM after BCS.…”

Section: Introductionmentioning

confidence: 99%

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A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

Bockstal

Agahozo

Koppert

et al. 2019

Intl Journal of Cancer

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Ductal carcinoma in situ (DCIS) of the breast is a nonobligate precursor of invasive breast cancer, accounting for 20 % of screen‐detected breast cancers. Little is known about the natural progression of DCIS because most patients undergo surgery upon diagnosis. Many DCIS patients are likely being overtreated, as it is believed that only around 50 % of DCIS will progress to invasive carcinoma. Robust prognostic markers for progression to invasive carcinoma are lacking. In the past, studies have investigated women who developed a recurrence after breast‐conserving surgery (BCS) and compared them with those who did not. However, where there is no recurrence, the patient has probably been adequately treated. The present narrative review advocates a new research strategy, wherein only those patients with a recurrence are studied. Approximately half of the recurrences are invasive cancers, and half are DCIS. So‐called “recurrences” are probably most often the result of residual disease. The new approach allows us to ask: why did some residual DCIS evolve to invasive cancers and others not? This novel strategy compares the group of patients that developed in situ recurrence with the group of patients that developed invasive recurrence after BCS. The differences between these groups could then be used to develop a robust risk stratification tool. This tool should estimate the risk of synchronous and metachronous invasive carcinoma when DCIS is diagnosed in a biopsy. Identification of DCIS patients at low risk for developing invasive carcinoma will individualize future therapy and prevent overtreatment.

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