Impact of Histopathological Factors, Patient History and Therapeutic Variables on Recurrence-free Survival after Ductal Carcinoma in Situ: 8-Year Follow-up and Questionnaire Survey

Abstract

!Introduction: Ductal carcinoma in situ (DCIS) is a premalignant lesion of the glandular component of the breast and a precursor lesion of invasive breast cancer. In recent decades the incidence of DCIS has risen continuously, mainly because of more extensive screening and more advanced diagnostic procedures. There is an increasing need for evidence-based treatment guidelines which will protect patients as far as possible from recurrence or invasive cancer but also from overtreatment. This retrospective single-center clinical trial analyzed recurrence-free survival times, rates of invasive and non-invasive events, and the impact of patient history, histopathological variables and therapeutic factors on recurrence-free survival times. Material and Methods: A total of 200 patients who underwent surgery between 2000 and 2007 for pure DCIS were included in the study. As part of follow-up a questionnaire was sent to patients and their respective gynecologists. Results: In the follow-up period, 12.5 % (n = 25) of the 200 patients had recurrence (invasive or noninvasive event). Menopausal status, tumor grade and tumor size were significantly associated with recurrence. Low-grade DCIS was significantly more often hormone receptor-positive than high-grade DCIS. Patients who had postoperative radiotherapy significantly more often also received endocrine drug treatment. There was a significant association between younger patient age and drug treatment. The study found that in the investigated cohort, premenopausal women had a significantly shorter recurrence-free time compared to postmenopausal women. Conclusion: This paper summarizes the current literature on DCIS. There is a need for more prospective clinical trials to improve the prognosis of premenopausal women with large and hormone receptor-positive DCIS. Zusammenfassung

Should local treatment of breast ductal carcinoma in situ be the same as the treatment of early invasive breast cancer

“…Intraductal spread of the disease in connection with an irregular routing of the ducts and difficulties in macroscopic evaluation of the scope of the lesions illustrates well the deceptive character of the disease and the widely understood heterogenicity of the DICS requires some significant evaluation of the therapeutic management [2]. The risk of development of an invasive form of cancer, which -depending on the subtype of DCIS -is 20-30% within 10 years and is 15 times greater than the average risk of breast cancer morbidity in the general population [3] of key importance for the choice of the scope of treatment.…”

“…The basic arguments for the treatment of ductal carcinoma in situ in the same way as early invasive cancer comprise: -unknown natural history of untreated DCIS [16]; -high risk of undervaluation of the invasive component in the core-needle biopsy [10,[16][17][18]; -increase of recurrence risk with the progress of time [3,[19][20][21]; -lack of verified separators of the groups with the risk of adverse course of the disease [1,2,20]; -the results of the clinical studies confirming the justification of combined local treatment [22][23][24][25][26]; -and the proof that the clinical course of DCIS is the same as early invasive breast cancer [27,28]; -the lack of clinical studies which could justify a limitation of the treatment scope [28][29][30]. Given the fact that a large share of ductal carcinoma in situ is diagnosed as a small lesion seen only in a mammography image, and then treated with a mammotomy biopsy, a substantial part of DCIS is resected during this procedure.…”

“…The recurrence risk increases with the progress of time and, given the unknown natural history of untreated DICS, the observations concerning disease recurrence are a source of knowledge of DICS biology and the effects on the therapy applied. In one-centre retrospective study comprising 200 patients, within an 8-year observation period, in 25 patients (12.5%) a disease recurrence was diagnosed, and the risk factors were the young age, tumour size and grade [3]. In a prospective multicentre trial, ECOG-ACRIN E5194 with an average observation period of 12.3 years, where the minimum cancer-free margin was more than 3 mm, special attention was paid to the group of patients with a potentially low recurrence risk low-grade DCIS.…”