Is DCIS Overrated?

Feinberg, Joshua A; Wetstone, Rachel; Greenstein, Dana; Borgen, Patrick I.

doi:10.1007/978-3-319-70197-4_5

Cited by 11 publications

(13 citation statements)

References 54 publications

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“…A statistically significant increase (p = 0.0001) was therefore observed in the incidence of this breast cancer type. DCIS incidence reported in the literature is approximately 20% [27,30,31], this is higher than the incidence of our centre. However, it must be considered, that DCIS is presented in a non-negligible percentage of cases associated with an infiltrating component, and these may have been included in the percentages of the cited studies.…”

Section: Discussioncontrasting

confidence: 58%

Pure Ductal Carcinoma In Situ of the Breast: Analysis of 270 Consecutive Patients Treated in a 9-Year Period

Chiappa

Bonetti

Jaber

et al. 2021

Cancers

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Introduction: Ductal carcinoma in situ (DCIS) is an intraductal neoplastic proliferation of epithelial cells that are confined within the basement membrane of the breast ductal system. This retrospective observational analysis aims at reviewing the issues of this histological type of cancer. Materials and methods: Patients treated for DCIS between 1 January 2009 and 31 December 2018 were identified from a retrospective database. The patients were divided into two groups of 5 years each, the first group including patients treated from 2009 to 2013, and the second group including patients treated from 2014 to 2018. Once the database was completed, we performed a statistical analysis to see if there were significant differences among the 2 periods. Statistical analyses were performed using GraphPad Prism software for Windows, and the level of significance was set at p < 0.05. Results: 3586 female patients were treated for breast cancer over the 9-year study period (1469 patients from 2009 to 2013 and 2117 from 2014 to 2018), of which 270 (7.53%) had pure DCIS in the final pathology. The median age of diagnosis was 59-year-old (range 36–86). In the first period, 81 (5.5%) women out of 1469 had DCIS in the final pathology, in the second, 189 (8.9%) out of 2117 had DCIS in the final pathology with a statistically significant increase (p = 0.0001). From 2009 to 2013, only 38 (46.9%) were in stage 0 (correct DCIS diagnosis) while in the second period, 125 (66.1%) were included in this stage. The number of patients included in clinical stage 0 increased significantly (p = 0.004). In the first period, 48 (59.3%) specimen margins were at a greater or equal distance than 2 mm (negative margins), between 2014 and 2018; 137 (72.5%) had negative margins. Between 2014 and 2018 the number of DCIS patients with positive margins decreased significantly (p = 0.02) compared to the first period examined. The mastectomies number increased significantly (p = 0.008) between the 2 periods, while the sentinel lymph node biopsy (SLNB) numbers had no differences (p = 0.29). For both periods analysed all the 253 patients who underwent the follow up are currently living and free of disease. We have conventionally excluded the 17 patients whose data were lost. Conclusion: The choice of the newest imaging techniques and the most suitable biopsy method allows a better pre-operative diagnosis of the DCIS. Surgical treatment must be targeted to the patient and a multidisciplinary approach discussed in the Breast Unit centres.

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Section: Discussioncontrasting

confidence: 58%

Pure Ductal Carcinoma In Situ of the Breast: Analysis of 270 Consecutive Patients Treated in a 9-Year Period

Chiappa

Bonetti

Jaber

et al. 2021

Cancers

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“…For instance, we did not observe worse survival in patients with noninvasive breast cancer who had delayed of treatment of >90 days postdiagnosis. This suggests that waiting time for patients to receive care can be optimized by taking into consideration the severity of the disease . However, timeliness of treatment should not be discounted as it affects the patient's mental well‐being and satisfaction .…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that waiting time for patients to receive care can be optimized by taking into consideration the severity of the disease. 15 However, timeliness of treatment should not be discounted as it affects the patient's mental well-being and satisfaction. 16 Studies on time to disease progression are needed to better guide clinical practice to improve quality of care.…”

Section: Discussionmentioning

confidence: 99%

Impact of delayed treatment in women diagnosed with breast cancer: A population‐based study

Cook

et al. 2020

Cancer Medicine

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The impact of timely treatment on breast cancer‐specific survival may differ by tumor stage. We aim to study the impact of delayed first treatment on overall survival across different tumor stages. In addition, we studied the impact of delayed adjuvant treatments on survival in patients with invasive nonmetastatic breast cancer who had surgery ≤90 days postdiagnosis. This population‐based study includes 11 175 breast cancer patients, of whom, 2318 (20.7%) died (median overall survival = 7.9 years). To study the impact of delayed treatment on survival, hazard ratios and corresponding 95% confidence intervals were estimated using Cox proportional‐hazards models. The highest proportion of delayed first treatment (>30 days postdiagnosis) was in patients with noninvasive breast cancer (61%), followed by metastatic breast cancer (50%) and invasive nonmetastatic breast cancer (22%). Delayed first treatment (>90 vs ≤30 days postdiagnosis) was associated with worse overall survival in patients with invasive nonmetastatic (HR: 2.25, 95% CI 1.55‐3.28) and metastatic (HR: 2.09, 95% CI 1.66‐2.64) breast cancer. Delayed adjuvant treatment (>90 vs 31‐60 days postsurgery) was associated with worse survival in patients with invasive nonmetastatic (HR: 1.50, 95% CI 1.29‐1.74). Results for the Cox proportional‐hazards models were similar for breast cancer‐specific death. A longer time to first treatment (31‐90 days postdiagnosis) may be viable for more extensive diagnostic workup and patient‐doctor decision‐making process, without compromising survival. However, patients’ preference and anxiety status need to be considered.

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“…In contrast to these high values, the minimum plausible rate of mastectomy-treated overdiagnosis that is indicated by our statistical methods is 0. Nonetheless, the statistical methods account for only some of what is known about breast cancer treatment, and commonsense reasoning suggests that breast cancer screening will lead to mastectomy being performed for at least a small proportion of overdiagnosed tumors, since mastectomy is undergone by a large proportion (27.4%) of women diagnosed with DCIS (see also [39]), and because it is generally agreed that at least some DCIS cases are overdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

Use of Mastectomy for Overdiagnosed Breast Cancer in the United States: Analysis of the SEER 9 Cancer Registries

Harding¹,

Pompei

Burmistrov

et al. 2019

Journal of Cancer Epidemiology

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Aim We investigated use of mastectomy as treatment for early breast cancer in the US and applied the resulting information to estimate the minimum and maximum rates at which mastectomy could plausibly be undergone by patients with overdiagnosed breast cancer. Little is currently known about overtreatments undergone by overdiagnosed patients. MethodsIn the US, screening is often recommended at ages ≥40. The study population was women age ≥40 diagnosed with breast cancer in the US SEER 9 cancer registries during 2013 (n=26,017). We evaluated first-course surgical treatments and their associations with case characteristics. Additionally, a model was developed to estimate probability of mastectomy conditional on observed case characteristics. The model was then applied to evaluate possible rates of mastectomy in overdiagnosed patients. To obtain minimum and maximum plausible rates of this overtreatment, we respectively assumed the cases that were least and most likely to be treated by mastectomy had been overdiagnosed. ResultsOf women diagnosed with breast cancer at age ≥40 in 2013, 33.8% received mastectomy. Mastectomy was common for most investigated breast cancer types, including for the early breast cancers among which overdiagnosis is thought to be most widespread: mastectomy was undergone in 26.4% of in situ and 28.0% of AJCC stage-I cases. These rates are substantively higher than in many European nations. The probability-based model indicated that between >0% and <18% of the study population could plausibly have undergone mastectomy for overdiagnosed cancer. This range reduced depending on the overdiagnosis rate, shrinking to >0% and <7% if 10% of breast cancers were overdiagnosed and >3% and <15% if 30% were overdiagnosed. Conclusions Screening-associated overtreatment by mastectomy is considerably less common than overdiagnosis itself but should not be assumed to be negligible. Screening can prompt or prevent mastectomy, and the balance of this harm-benefit tradeoff is currently unclear.

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Is DCIS Overrated?

Cited by 11 publications

References 54 publications

Pure Ductal Carcinoma In Situ of the Breast: Analysis of 270 Consecutive Patients Treated in a 9-Year Period

Pure Ductal Carcinoma In Situ of the Breast: Analysis of 270 Consecutive Patients Treated in a 9-Year Period

Impact of delayed treatment in women diagnosed with breast cancer: A population‐based study

Use of Mastectomy for Overdiagnosed Breast Cancer in the United States: Analysis of the SEER 9 Cancer Registries

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