Breast cancer–specific mortality after invasive local recurrence in patients with ductal carcinoma-in-situ of the breast

Lee, Laura A.; Silverstein, Melvin J.; Chung, Charles S.; MacDonald, Heather; Sanghavi, Premal; Epstein, Melinda S.; Holmes, Dennis R.; Silberman, Howard; Ye, Wei; Lagios, Michael D.

doi:10.1016/j.amjsurg.2006.06.005

Cited by 68 publications

(50 citation statements)

References 15 publications

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“…Although dcis is not life-threatening, up to 20% of women with dcis can develop invasive breast cancer at 10 years, which is associated with an increased risk of breast cancer mortality [1][2][3][4][5][6] . The goals of treating dcis are to maximize breast conservation, optimize cosmesis, and prevent the development of invasive breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Kong¹,

Narod²,

Taylor³

et al. 2013

Curr. Oncol.

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also significantly associated with invasive lr (hr: 1.6; 95% ci: 1.0 to 2.4; p = 0.04). ConclusionsAge at diagnosis is a strong predictor of lr in women with dcis after treatment with bcs and radiotherapy. KEY WORDSDuctal carcinoma in situ, age, recurrence, young patients, radiation BACKGROUNDDuctal carcinoma in situ (dcis) is a noninvasive form of breast cancer that is most often diagnosed during mammographic screening. Although dcis is not life-threatening, up to 20% of women with dcis can develop invasive breast cancer at 10 years, which is associated with an increased risk of breast cancer mortality [1][2][3][4][5][6] . The goals of treating dcis are to maximize breast conservation, optimize cosmesis, and prevent the development of invasive breast cancer. Most women with dcis are treated with breastconserving surgery (bcs), followed by whole-breast irradiation. Radiotherapy after bcs has been proved to reduce the rate of local recurrence (both in situ and invasive) 7-12 . Randomized and nonrandomized clinical trials report that after bcs and radiation, approximately 12%-15% of women will experience a local recurrence within 10 years, and 5%-10% will develop an invasive local recurrence [7][8][9][10][11][12] .It is important to identify factors associated with the development of local recurrence and subsequent invasive breast cancer, because women with such factors may be candidates for more extensive therapy. It has been suggested that younger age at diagnosis is a risk factor for local recurrence after treatment for dcis 7,12-14 . Multivariable analyses from randomized clinical trials suggest that the efficacy of radiation ABSTRACT PurposeThe main goal of treating ductal carcinoma in situ (dcis) is to prevent the development of invasive breast cancer. Most women are treated with breastconserving surgery (bcs) and radiotherapy. Age at diagnosis may be a risk factor for recurrence, leading to concerns that additional treatment may be necessary for younger women. We report a populationbased study of women with dcis treated with bcs and radiotherapy and an evaluation of the effect of age on local recurrence (lr). MethodsAll women diagnosed with dcis in Ontario from 1994 to 2003 were identified. Treatments and outcomes were collected through administrative databases and validated by chart review. Women treated with bcs and radiotherapy were included. Survival analyses were performed to evaluate the effect of age on outcomes. ResultsWe identified 5752 cases of dcis; 1607 women received bcs and radiotherapy. The median follow-up was 10.0 years. The 10-year cumulative lr rate was 27% for women younger than 45 years, 14% for women 45-50 years, and 11% for women more than 50 years of age (p < 0.0001). The 10-year cumulative invasive lr rate was 22% for women younger than 45 years, 10% for women 45-50 years, and 7% for women more than 50 years of age (p < 0.0001). On multivariate analyses, young age (<45 years) was significantly associated with lr and invasive lr [hazard ratio (hr) for lr: 2.6; 95% confidence interval...

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Section: Introductionmentioning

confidence: 99%

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Kong¹,

Narod²,

Taylor³

et al. 2013

Curr. Oncol.

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“…The risk of LR for clinically-evident DIN is approximately twice that of mammographically-detected DIN [47]. However, the recurrences after BCS are today diagnosed at a very early stage and almost always treated successfully; for that reason, breast cancer 6 mortality in these patients is very low, about 1% [48][49] and probably due to an underestimated histological evaluation.…”

Section: Surgical Treatmentmentioning

confidence: 99%

The management of ductal intraepithelial neoplasia (DIN): open controversies and guidelines of the Istituto Europeo di Oncologia (IEO), Milan, Italy

Farante

Zurrida

Galimberti

et al. 2010

Breast Cancer Res Treat

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“…Clinical outcomes following mastectomy for DCIS are excellent, with both clinical trial and population-based studies consistently reporting a 1%-2% rate of local recurrence with long-term follow-up compared with approximately 10%-15% following breast conservation and radiation (19)(20)(21)(22). The increased local recurrence risk with breast conservation has not been shown to affect breast cancer-specific survival when compared to patients undergoing mastectomy for DCIS, with both groups exhibiting up to a 99% long-term breast cancer-specific survival (19,23).…”

mentioning

confidence: 95%

“…The increased local recurrence risk with breast conservation has not been shown to affect breast cancer-specific survival when compared to patients undergoing mastectomy for DCIS, with both groups exhibiting up to a 99% long-term breast cancer-specific survival (19,23). The National Surgical Adjuvant Breast and Bowel Project has reported that in their DCIS trials, women with DCIS who recur with invasive cancer after treatment have a twofold greater mortality risk relative to those without invasive recurrence (hazard ratio = 2.08, 95% confidence interval = 1.46% to 2.98%) (24).…”

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confidence: 99%

The Impact of Surgery on Ductal Carcinoma In Situ Outcomes: The Use of Mastectomy

Hwang

2010

JNCI Monographs

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Genomic and phenotypic similarities between ductal carcinoma in situ (DCIS) and invasive breast cancer support that DCIS is likely a nonobligate precursor of invasive ductal cancer. Because it remains difficult to predict which individuals with DCIS will develop invasive cancer without excision, surgery has long been the mainstay of treatment for women diagnosed with DCIS. Presently in the United States, 97% of patients with DCIS undergo surgical excision, of which one-third will involve mastectomy (1,2). The most recent NCCN Clinical Practice Guidelines in Oncology (v.2.2010) recommend total mastectomy as one treatment option for DCIS (3). General guidelines for the use of mastectomy in DCIS have been suggested by an expert panel convened by the American College of Radiology (4) and recommend that patients with extensive and/or multifocal DCIS involving 4-5 cm of disease or more than one quadrant should be offered mastectomy. In addition to these patients, women with potential contraindications to breast irradiation or a strong preference for mastectomy over breast conservation have been considered appropriate candidates for this procedure.In the United States, the use of mastectomy for treatment of DCIS has declined steadily. Among the cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) Program, 43% of women with DCIS underwent mastectomy in 1992 compared with 28% in 1999 (1). However, significant variations in surgical treatment patterns for DCIS persist among SEER sites: between 1997 and 2000, those treated with mastectomy for DCIS ranged from the highest rate of 50.5% in Utah to the lowest rate of 23.1% in Connecticut (5). Factors reported to be associated with a higher likelihood of mastectomy for DCIS have included young age at diagnosis, geographic site, and white race (5,6). Following treatment for DCIS, the risk of contralateral breast events has been shown to be 4.5/1000 personyears (7). Despite this increased contralateral breast cancer risk, few women have previously undergone contralateral prophylactic surgery for DCIS. However, there has been a recent surge in the prevalence of contralateral prophylactic mastectomy (CPM), and between 1998 to 2005, the CPM rate in women with DCIS increased from 2.1% to 5.2% (8). Factors contributing to this increase most certainly include the inaccurate perception many women with DCIS harbor regarding their future risk for invasive cancer (9), although improved reconstructive outcomes and more widespread use of magnetic resonance imaging have also been proposed as contributing causes.Various surgical approaches for mastectomy are currently used and include simple mastectomy (excision of breast tissue and overlying skin), skin-sparing mastectomy (removal of breast with preservation of the skin envelope), and most recently, nipple-preserving mastectomy techniques. None of these approaches appear to confer increased risk of local recurrence over the others, provided that conscientious attention is given to performing a complete ex...

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Breast cancer–specific mortality after invasive local recurrence in patients with ductal carcinoma-in-situ of the breast

Cited by 68 publications

References 15 publications

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

The management of ductal intraepithelial neoplasia (DIN): open controversies and guidelines of the Istituto Europeo di Oncologia (IEO), Milan, Italy

The Impact of Surgery on Ductal Carcinoma In Situ Outcomes: The Use of Mastectomy

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