Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast – Results from the Swedish randomised trial

Ringberg, Anita; Nordgren, Hans; Thorstensson, Sten; Idvall, Ingrid; Garmo, Hans; Granstrand, Bengt; Arnesson, L-G; Sandelin, Kerstin; Wallgren, Arne; Anderson, Harald; Emdin, Stefan O.; Holmberg, Lars

doi:10.1016/j.ejca.2006.09.018

Cited by 76 publications

(54 citation statements)

References 15 publications

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“…It is known from randomised controlled trials that radiotherapy after breast-conserving surgery for BCIS reduces recurrences in the ipsilateral breast (Fisher et al, 1993;Fisher et al, 1998;Julien et al, 2000;Houghton et al, 2003;Bijker et al, 2006;Emdin et al, 2006;Ringberg et al, 2007). We also found this protective effect of radiotherapy on the subsequent development of invasive cancer in the ipsilateral breast (HR 0.40;).…”

Section: Discussionsupporting

confidence: 61%

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

2008

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Approximately 1 in every 600 women attending breast-screening programmes in the United Kingdom is diagnosed with breast carcinoma in situ (BCIS). However, there is little information on the occurrence of subsequent cancers (other than second breast cancers) in these women. We investigated the occurrence of invasive cancers in 12 836 women diagnosed with BCIS in southeast England between 1971 and 2003, using data from the Thames Cancer Registry. A greater than expected number of subsequent cancers was found for two sites: breast (standardised incidence ratio (SIR) 1.96; 95% confidence interval (CI) 1.79 -2.14) and corpus uteri (SIR 1.42; 95% CI 1.11 -1.78). For subsequent ipsilateral breast cancer in those treated with breast conservation, the excess was independent of the time since diagnosis of BCIS, whereas for subsequent contralateral breast cancer, there was a steady decline in excess over time. For subsequent uterine cancer, the excess became statistically significant only at 45 years after BCIS diagnosis, consistent with a treatment effect. This was further supported by Cox regression anaysis: the risk of subsequent uterine cancer was significantly increased in women receiving hormonal therapy compared with those not receiving it, with a hazard ratio of 2.97 (95% CI 1.84 -4.80). (2008) Currently, approximately 1 in every 600 women attending breastscreening programmes in the United Kingdom is diagnosed with breast carcinoma in situ (BCIS). This amounted to almost 3000 cases in 2004 (NHS Cancer Screening Programmes, 2006. The most common form of treatment is lumpectomy, with or without radiotherapy, although women with a more diffuse pattern of BCIS may undergo mastectomy. A number of previous studies have focused on the risk of second breast cancer following a diagnosis of BCIS (Habel et al, 1997;Wärnberg et al, 2000;Claus et al, 2003;Levi et al, 2005;Rawal et al, 2005), with estimates of relative risk generally of the order of two-to fivefold. Few studies have looked at the occurrence of subsequent invasive cancers at other sites (Ward et al, 1992;Franceschi et al, 1998;Soerjomataram et al, 2006), and these were based on relatively small numbers of cases. British Journal of CancerIn the current population-based study, we have investigated the occurrence of subsequent invasive cancers in a very large series of unselected women with BCIS in southeast England. We have also examined the relationship between treatment for BCIS and the development of subsequent cancers. MATERIALS AND METHODSAll recorded cases of BCIS (ICD10 code D05) diagnosed in women between 1971 and 2003 were extracted from the Thames Cancer Registry (TCR) database. The TCR is a population-based registry covering London and a large part of southeast England. Patients with any other cancers diagnosed prior to, or at the same time as, BCIS were excluded in order to avoid confounding the sequelae of BCIS with those of other cancers, particularly breast cancer. The occurrence of subsequent cancers was analysed by calculating the standardised inc...

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Section: Discussionsupporting

confidence: 61%

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

2008

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“…Many studies are available on the association between comedonecrosis and local recurrence. The results of four RCTs showed a consistent increased risk of IBTR in patients with comedonecrosis, ranging from 1.3 to 5.0 [16,17,19,20]. The results from 11 observational studies showed that comedonecrosis increased IBTR, ranging from 0.7 to 9.3 [23, 24, 28, 34-37, 39, 42, 44, 47].…”

Section: Comedonecrosismentioning

confidence: 90%

Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis

Wang

Shamliyan

Virnig

et al. 2011

Breast Cancer Res Treat

135

106

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While ductal carcinoma in situ (DCIS) is seldom life threatening, the management of DCIS remains a dilemma for patients and their physicians. Aggressive treatment reduces the risk of ipsilateral breast tumor recurrence (IBTR), but has never been proven to improve survival. There is interest in identifying the prognostic factors for determining low-risk DCIS patients, but a comprehensive review of high-quality evidence on tumor characteristics in predicting local recurrence has never been carried out. We examined the following tumor characteristics: biomarkers, comedonecrosis, focality, surgical margin, method of detection, tumor grade, and tumor size. For this systematic review we restricted the analyses to the results of subgroup analyses from randomized controlled trials (RCTs) and multivariate analyses from RCTs and observational studies. We identified 44 eligible articles. The pooled random-effects risk estimates for IBTR are comedonecrosis 1.71(95% CI, 1.36-2.16), focality 1.95(95% CI, 1.59-2.40), margin 2.25(95% CI, 1.77-2.86), method of detection 1.35(95% CI, 1.12-1.62), tumor grade 1.81(95% CI, 1.53-2.13), and tumor size 1.63(95% CI, 1.30-2.06). Limited evidence indicated that women whose DCIS is ER-negative, PR-negative, or HER2/neu receptor positive have an IBTR higher than those whose DCIS is ER-positive, PR-positive, and HER2/neu receptor negative. A variety of tumor characteristics are significant predictors for IBTR. These results are important for both clinicians and patients to interpret the risk of local recurrence and to decide on a course of treatment.

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“…Patients with high grade disease had a significantly increased risk of ipsilateral breast recurrence (15.3% at 7 years vs. 6.1% in those low and intermediate grade lesions, HR 0.53) [59]. A casecohort of 161 cases of ipsilateral breast events in a population of 1,046 women in the Swedish DCIS trial found that low grade and absence of necrosis decreased the risk of ipsilateral breast events by half [60]. Another multi-institutional study with 268 patients who underwent BCS with RT for DCIS demonstrated that while the combination of high grade lesions with comedo necrosis was a significant risk factor for recurrence at 5-year follow-up, this effect was no longer true at 10-year follow.…”

Section: Pathological Featuresmentioning

confidence: 97%

“…2,622 RCT No Not specified Cuzick et al [28] 1,694 RCT Yes Not specified EBCTCG [31] 3,729 RCT review Yes Not specified Vicini et al [39] 145 SIC Yes >7 mm Collins et al [44] 2,995 MIC Yes >15 low powered fields Bailes et al [46] 1,902 SIC Yes Not specified Melstrom et al [49] 546 SIC Yes Not specified Thomas et al [50] 2,564 MIC Yes >1.5 cm Holmes et al [51] 141 SIC Yes Not specified Dillon et al [52] 135 SIC Yes >3 cm Goldstein et al [53] 132 SIC No Not specified O'Sullivan et al [54] 2,770 SIC Yes (reverse effect) Not specified MacDonald et al [56] 455 SIC Yes Not specified Kerlikowske et al [57] 1,036 MIC Yes >1 cm Wai et al [58] 460 MIC Yes >4 cm Hughes et al [59] 671 MIC No Not specified Ringberg et al [60] 161 SIC No Not specified Solin et al [61] 268 MIC No Not specified Bijker et al [68] 1,010 RCT No Not specified SIC, single institution cohort; MIC, multi-institution cohort; RCT, randomized control trial.…”

mentioning

confidence: 98%

Breast conserving therapy for DCIS—Does size matter?

Kantor

Winchester

2014

Journal of Surgical Oncology

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Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast – Results from the Swedish randomised trial

Cited by 76 publications

References 15 publications

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

The occurrence of invasive cancers following a diagnosis of breast carcinoma in situ

Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis

Breast conserving therapy for DCIS—Does size matter?

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