Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

Thompson, Alastair; Clements, Karen; Cheung, Shan; Pinder, Sarah; Lawrence, Gill; Sawyer, Elinor J.; Kearins, Olive; Ball, Graham; Tomlinson, Ian; Hanby, Andrew M.; Jsj., Thomas; Maxwell, Anthony; Wallis, Matthew; Dodwell, David

doi:10.1016/j.ejca.2018.06.027

Cited by 63 publications

(56 citation statements)

References 30 publications

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“…Since mortality does not seem to be substantial after a diagnosis of DCIS, the primary concern is defining the risk that untreated DCIS progresses to invasive disease or that surgically treated DCIS recurs as DCIS or as invasive cancer, as an invasive recurrence may affect survival. Looking into type of breast surgery offered, breast conservation becomes more common with older age, reaching a plateau after 60 y, according to a report from the Sloane Project [52]. Two studies from the USA [37,38] also showed that this trend is larger for women N70y, implying that older age does not only affect whether surgery will be offered, but also type of surgery, with a trend to avoid mastectomy.…”

Section: Surgical Treatment and Outcomesmentioning

confidence: 99%

The challenge of avoiding over- and under-treatment in older women with ductal cancer in situ: A scoping review of existing knowledge gaps and a meta-analysis of real-world practice patterns

Karakatsanis

Markopoulos

2020

Journal of Geriatric Oncology

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Section: Surgical Treatment and Outcomesmentioning

confidence: 99%

The challenge of avoiding over- and under-treatment in older women with ductal cancer in situ: A scoping review of existing knowledge gaps and a meta-analysis of real-world practice patterns

Karakatsanis

Markopoulos

2020

Journal of Geriatric Oncology

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“…Moreover, only a minority of DCIS patients will benefit from these findings, since only 9-12% of DCIS are low grade. 13,24,[40][41][42] Additional inclusion criteria besides nuclear grade will further decrease the number of eligible patients. The overall impact of active surveillance trials on the population of DCIS patients might therefore be limited.…”

Section: Is Active Surveillance a Noninferior Alternative?mentioning

confidence: 99%

“…Patient recruitment might be facilitated by including patients of previously conducted randomized clinical trials and retrospective studies, of which a nonexhaustive selection is summarized in Table 2. 17,19,20,24,41,70,[90][91][92][93][94][95][96][97] Inclusion of these patients in a study conducted according to the new research strategy would allow for correction of treatment effects, since a substantial number of patients are treated with radiotherapy and/or TAM after BCS. Additionally, it would be interesting to also include HER2-positive DCIS patients with recurrences from the currently ongoing NSABP B-43 trial, wherein the value of adjuvant trastuzumab is investigated.…”

Section: Practical Implementation Of the Alternative Research Strategymentioning

confidence: 99%

“…Even if these active surveillance trials prove that watchful waiting is not inferior compared to standard treatment, it will take many years before these data will be available for routine clinical use. Moreover, only a minority of DCIS patients will benefit from these findings, since only 9–12% of DCIS are low grade . Additional inclusion criteria besides nuclear grade will further decrease the number of eligible patients.…”

Section: Introductionmentioning

confidence: 99%

“…A multicenter approach seems therefore mandatory, to enable the inclusion of a sufficiently large number of DCIS patients with subsequent recurrence. Patient recruitment might be facilitated by including patients of previously conducted randomized clinical trials and retrospective studies, of which a nonexhaustive selection is summarized in Table . Inclusion of these patients in a study conducted according to the new research strategy would allow for correction of treatment effects, since a substantial number of patients are treated with radiotherapy and/or TAM after BCS.…”

Section: Introductionmentioning

confidence: 99%

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A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

Bockstal

Agahozo

Koppert

et al. 2019

Intl Journal of Cancer

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Ductal carcinoma in situ (DCIS) of the breast is a nonobligate precursor of invasive breast cancer, accounting for 20 % of screen‐detected breast cancers. Little is known about the natural progression of DCIS because most patients undergo surgery upon diagnosis. Many DCIS patients are likely being overtreated, as it is believed that only around 50 % of DCIS will progress to invasive carcinoma. Robust prognostic markers for progression to invasive carcinoma are lacking. In the past, studies have investigated women who developed a recurrence after breast‐conserving surgery (BCS) and compared them with those who did not. However, where there is no recurrence, the patient has probably been adequately treated. The present narrative review advocates a new research strategy, wherein only those patients with a recurrence are studied. Approximately half of the recurrences are invasive cancers, and half are DCIS. So‐called “recurrences” are probably most often the result of residual disease. The new approach allows us to ask: why did some residual DCIS evolve to invasive cancers and others not? This novel strategy compares the group of patients that developed in situ recurrence with the group of patients that developed invasive recurrence after BCS. The differences between these groups could then be used to develop a robust risk stratification tool. This tool should estimate the risk of synchronous and metachronous invasive carcinoma when DCIS is diagnosed in a biopsy. Identification of DCIS patients at low risk for developing invasive carcinoma will individualize future therapy and prevent overtreatment.

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Variability in grading of ductal carcinoma in situ among an international group of pathologists

Seijen

Jóźwiak

Pinder

et al. 2021

The Journal of Pathology CR

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The prognostic value of cytonuclear grade in ductal carcinoma in situ (DCIS) is debated, partly due to high interobserver variability and the use of multiple guidelines. The aim of this study was to evaluate interobserver agreement in grading DCIS between Dutch, British, and American pathologists. Haematoxylin and eosin-stained slides of 425 women with primary DCIS were independently reviewed by nine breast pathologists based in the Netherlands, the UK, and the USA. Chance-corrected kappa (κ ma ) for association between pathologists was calculated based on a generalised linear mixed model using the ordinal package in R. Overall κ ma for grade of DCIS (low, intermediate, or high) was estimated to be 0.50 (95% confidence interval [CI] 0.44-0.56), indicating a moderate association between pathologists. When the model was adjusted for national guidelines, the association for grade did not change (κ ma = 0.53; 95% CI 0.48-0.57); subgroup analysis for pathologists using the UK pathology guidelines only had significantly higher association (κ ma = 0.58; 95% CI 0.56-0.61). To assess if concordance of grading relates to the expression of the oestrogen receptor (ER) and HER2, archived immunohistochemistry was analysed on a subgroup (n = 106). This showed that non-high grade according to the majority opinion was associated with ER positivity and HER2 negativity (100 and 89% of non-high grade cases, respectively). In conclusion, DCIS grade showed only moderate association using whole slide images scored by nine breast pathologists. As therapeutic decisions and inclusion in ongoing clinical trials are guided by DCIS grade, there is a pressing need to reduce interobserver variability in grading. ER and HER2 might be supportive to prevent the accidental and unwanted inclusion of high-grade DCIS in such trials.

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Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

Cited by 63 publications

References 30 publications

The challenge of avoiding over- and under-treatment in older women with ductal cancer in situ: A scoping review of existing knowledge gaps and a meta-analysis of real-world practice patterns

The challenge of avoiding over- and under-treatment in older women with ductal cancer in situ: A scoping review of existing knowledge gaps and a meta-analysis of real-world practice patterns

A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

Variability in grading of ductal carcinoma in situ among an international group of pathologists

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