Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

Abstract

Purpose We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994 and to estimate the all-cause mortality excess risk of diagnosed women. Methods Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). Results Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). Conclusions Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

Cardiovascular events and mortality in a population-based cohort initially diagnosed with ductal carcinoma in situ

“…Although all-cause mortality of women initially diagnosed with DCIS was higher than the control group in the crude model, it was attenuated after adjustment for age at diagnosis, income, residence and comorbidities. This observation is consistent with previous population-based studies reporting similar or slightly lower mortality risk in pure DCIS patients compared to the general population [ 8 , 9 , 11 , 12 , 17 , 18 ]. A notable finding in this study is that the increased mortality risk was attenuated after adjustment for comorbidities, even in women with a subsequent diagnosis of invasive disease (DCIS+Invasive group).…”

No Excess Mortality up to 10 Years in Early Stages of Breast Cancer in Women Adherent to Oral Endocrine Therapy: A Probabilistic Graphical Modeling Approach

“…However, survival estimates for these women using the combined cohort could be slightly lower than the observed survival in the original cohort, and this could limit the use of this subset of data. On the other hand, a previous study carried out on a cohort with ductal carcinoma in situ and diagnosed in Girona also detected statistically significant EM in patients diagnosed before 50 years of age [ 40 ]. Evidence suggests that differences in biological characteristics of breast tumors could impact patient survival [ 41 ].…”

“…Studies of EM derived from small cohorts of cancer patients must be further evaluated using larger cohorts [ 40 ]. Here, we present a procedure for simulating a large sample dataset by fitting graphical models to cohort data and coupling a log-linear model and a Bayesian network.…”

Low progesterone receptor levels in high-grade DCIS correlate with HER2 upregulation and the presence of invasive components

“…Each subtype was sorted into three subcategories: “Pure” ( n = 306) meaning those without an invasive component; “W/invasive” ( n = 51) meaning those with an invasive component; and “All” ( n = 357) meaning the entire group of the given subtype. We decided to split the patients based on age (younger than 50 and older than 50), taking into account other studies that looked at the incidence and mortality rate of DCIS ( 2 , 24 ).…”