Management of ductal carcinoma <i>in situ</i> according to Van Nuys Prognostic Index in Australia and New Zealand

Whitfield, Robert J.; Kollias, James; Silva, Primali de; Turner, Jenna; Maddern, Guy J.

doi:10.1111/j.1445-2197.2012.06133.x

Cited by 9 publications

(10 citation statements)

References 32 publications

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“…In contrast, most recurrences were in the intermediate risk group who received postoperative RT. As in other studies, we observed no “RT-effect” in our low risk group (Lee et al 2013; Whitfield et al 2012; Asjoe et al 2007). Contrary to previous findings, no “RT-effect” was observed in our intermediate risk group.…”

Section: Discussionsupporting

confidence: 86%

“…Attempts to validate the VNPI scoring system have yielded mixed results (MacAusland et al 2007; Di Saverio et al 2008; Gilleard et al 2008; Altintas et al 2011; Lee et al 2013; Whitfield et al 2012; Asjoe et al 2007). Such studies have had uneven population distributions, with most patients having low to intermediate scores.…”

Section: Discussionmentioning

confidence: 99%

“…Although patient age, tumor size, and tumor grade were set at patient diagnosis, margin width may be downgraded by re-excision or TM. Such efforts to salvage treatment have resulted in a disproportionately low rate of patients with high VNPI scores (MacAusland et al 2007; Di Saverio et al 2008; Whitfield et al 2012). A prospective trial with a short follow-up time found that, in the absence of RT or tamoxifen, downscoring the risk of recurrence made it impossible to analyze factors normally because of the small number of recurrences (Wong et al 2006).…”

Section: Discussionmentioning

confidence: 99%

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Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

et al. 2014

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Identifying ductal carcinoma in situ (DCIS) patients at highest risk for recurrence after breast conserving surgery (BCS) remains a clinical concern. Subjecting all such patients to radiotherapy may be unnecessary. The Van Nuys Prognostic Index (VNPI) is a simple scoring system for predicting the risk of local recurrence in patients with DCIS. We reviewed patients with DCIS applying the VNPI score system. A total of 184 DCIS patients who underwent surgery at our institution between January 2003 and December 2011 were identified. Patients were not treated according to VNPI guidelines; rather, radiation therapy was applied at each surgeon’s discretion. All patients with hormonal receptor positive tumors were treated with hormonal therapy. Pathology reports were reviewed and VNPI scores of each DCIS calculated. Of the 184 patients, 52 (28.3%), 115 (62.5%) and 17 (9.2%) had low, intermediate and high VNPI scores, respectively. Six of the 184 patients (3.3%) developed ipsilateral local recurrence, five in the intermediate and one in the high VNPI score group. Of the five in the intermediate group, three (60%) were in patients with ER-negative tumors. VNPI score itself was not associated with recurrence (P = 0.145). Factors associated with recurrence included tumor size (hazard ratio [HR] 6.88), grade (HR 9.07) and hormone receptor status (HR 11.75). Radiotherapy did not significantly improve recurrence rates in patients with low and intermediate risk DCIS, especially in those with ER-positive tumors. Radiotherapy can be omitted in patients with ER-positive intermediate score DCIS and in patients with low score DCIS.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

et al. 2014

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“…Physicians surveyed in England and the United States indicated that explaining DCIS and justifying treatment to women were difficult [ 9 , 10 ]. Other studies found variation in the language clinicians used to describe DCIS, with many referring to it as cancer, and variation in treatment patterns [ 11 , 12 ]. Women with DCIS worldwide have reported suboptimal communication, poor health care experiences, and adverse health outcomes [ 13 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

National consensus recommendations on patient-centered care for ductal carcinoma in situ

Gagliardi

Wright

Hong

et al. 2019

Breast Cancer Res Treat

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Purpose The purpose of this research was to generate recommendations on strategies to achieve patient-centered care (PCC) for ductal carcinoma in situ (DCIS). Methods Thirty clinicians (surgeons, medical/radiation oncologists, radiologists, nurses, navigators) who manage DCIS and 32 DCIS survivors aged 18 or older were nominated. Forty-six recommendations to support PCC for DCIS were derived from primary research, and rated in a two-round Delphi process from March to June 2018. Results A total of 29 clinicians and 27 women completed Round One, and 28 clinicians and 22 women completed Round Two. The 29 recommendations retained by both women and clinicians reflected the PCC domains of fostering patient–physician relationship (5), exchanging information (5), responding to emotions (1), managing uncertainty (4), making decisions (9), and enabling patient self-management (5). An additional 13 recommendations were retained by women only: fostering patient–physician relationship (1), exchanging information (3), responding to emotions (2), making decisions (3), and enabling patient self-management (4). Some recommendations refer to processes (i.e., ask questions about lifestyle or views about risks/outcomes to understand patient preferences); others to tools (i.e., communication aid). Panelists recommended a separate consensus process to refine the language that clinicians use when describing DCIS. Conclusions This is the first study to generate guidance on how to achieve PCC for DCIS. Organizations that deliver or oversee health care can use these recommendations on PCC for DCIS to plan, evaluate, or improve services. Ongoing research is needed to develop communication tools, and establish labels and language for DCIS that optimize communication. Electronic supplementary material The online version of this article (10.1007/s10549-019-05132-z) contains supplementary material, which is available to authorized users.

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“…This system has been confirmed as a good prognosis factor by a recent cohort study of 4578 patients diagnosed with DCIS enrolled by Whitfield and al. [4].…”

Section: Surgery and Radiotherapymentioning

confidence: 99%

Overview of Ductal Carcinoma <i>in Situ</i> of the Breast

Gaye¹,

Kasse²

2014

JCT

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Management of ductal carcinoma in situ according to Van Nuys Prognostic Index in Australia and New Zealand

Abstract: Significant differences in the management of DCIS according to VNPI groups were observed. The results suggest the possibility that some patients in the low-risk group were over-treated, while a proportion of patients in the intermediate- and high-risk groups were under-treated.

Cited by 9 publications

References 32 publications

Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

National consensus recommendations on patient-centered care for ductal carcinoma in situ

Overview of Ductal Carcinoma <i>in Situ</i> of the Breast

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Management of ductal carcinoma in situ according to Van Nuys Prognostic Index in Australia and New Zealand

Abstract: Significant differences in the management of DCIS according to VNPI groups were observed. The results suggest the possibility that some patients in the low-risk group were over-treated, while a proportion of patients in the intermediate- and high-risk groups were under-treated.

Cited by 9 publications

References 32 publications

Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

National consensus recommendations on patient-centered care for ductal carcinoma in situ

Overview of Ductal Carcinoma &lt;i&gt;in Situ&lt;/i&gt; of the Breast

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Overview of Ductal Carcinoma <i>in Situ</i> of the Breast