Impact of a prior diagnosis of DCIS on survival from invasive breast cancer

Abstract

A diagnosis of invasive breast cancer after DCIS can be described as a new primary cancer or as a local invasive recurrence. It is of interest to determine if, among women with early-stage breast cancer, a past history of DCIS influences survival. We retrieved the records of 306,249 women diagnosed with stage I or stage II breast cancer between 2004 and 2012, in the surveillance, epidemiology, and end results registries database, of whom 5395 had a previous diagnosis of DCIS. For each patient, we extracted information on the year of diagnosis, age at diagnosis, tumor size, nodal status, grade, estrogen receptor status, type of surgery (lumpectomy/mastectomy), use of radiotherapy (no/yes), prior DCIS (no/yes), cause of death, and follow-up time. For each case with prior DCIS, we recorded information on the year of diagnosis of DCIS, laterality of DCIS, and treatments received for DCIS. We matched 3979 patients with a prior DCIS to 3979 patients without a prior DCIS, according to the various prognostic features of the invasive cancer. We estimated the risk of death from breast cancer for patients with invasive ductal carcinoma, with and without a prior diagnosis of DCIS. We identified 306,249 women with stage I/II breast cancer, of whom 2335 had a prior ipsilateral DCIS and 3060 had a prior contralateral DCIS. Breast cancer-specific survival at 9 years was 94.6 % for patients with a prior DCIS (ipsilateral or contralateral) and was 95.2 % for patients with no prior DCIS (p = 0.32). In a matched analysis (3979 matched pairs), the hazard ratio for death from breast cancer for patients with a prior ipsilateral DCIS, compared to patients with no prior DCIS, was 0.91 (95 % CI = 0.49-1.68; p = 0.75). A prior diagnosis of ipsilateral DCIS does not impact upon the prognosis of women with early-stage invasive breast cancer. This suggests that primary breast cancers and local invasive recurrences following DCIS are similar conditions and should be treated in the same way.

Prognosis of local invasive relapses after carcinoma in situ of the breast: a retrospective study from a population-based registry

“…The IBCs mainly harbored favorable clinicopathologic characteristics, with the majority of cases being the ductal subtype, stage I (pT1 N0), SBR grade I-II, ER positive, and HER2 negative. These data are in accordance with the previous studies by Romero [8], Silverstein [7], and Sopik [9], where patients with ILR after prior ipsilateral DCIS mainly had same good prognosis features (stage I tumors, SBR grade II, and positive ER status).…”

“…Although outcomes in patients with non-invasive recurrence are excellent, data are sparse regarding outcomes after invasive recurrence [ 8 ], and existing data in the literature are conflicting concerning the prognosis of this entity per se. Indeed, some studies have reported that patients with invasive recurrence after primary DCIS have a particularly poor prognosis [ 8 ], while others have reported no difference in prognosis for women who experience invasive breast cancer (IBC), with or without prior DCIS [ 9 ]. Therefore, the question of invasive ipsilateral relapse management after DCIS remains unresolved, especially regarding the specific need for additional adjuvant systemic treatment.…”

Prognosis of local invasive relapses after carcinoma in situ of the breast: A retrospective study from a population-based registry

“…The IBCs mainly harbored favorable clinicopathologic characteristics, with the majority of cases being the ductal subtype, stage I (pT1 N0), SBR grade I-II, ER positive and HER2 These data are in accordance with previous studies by Romero (8), Silverstein (7) and Sopik (9), where patients with ILR after prior ipsilateral DCIS mainly had same good prognosis features (stage I tumors, SBR grade II and positive ER status).…”

Is invasion a necessary step for metastases in breast cancer?

“…From the starting point of DCIS, risk factors which lead from progression of DCIS to invasive cancer include young age, high grade, and positive surgical margins [ 52 ]. From the point of view of the invasive cancer, the most important factor which predicts a prior diagnosis of DCIS is calendar year [ 53 ]. If we surmise correctly, breast cancers with and without a documented prior history of DCIS should carry a similar prognosis.…”