Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

Nelson, Carl; Bai, Harrison X.; Neboori, Hanmanth J.; Takita, Cristiane; Motwani, S.B.; Wright, Jean L.; Hobeika, Georges; Haffty, Bruce G.; Jones, T.K.; Goyal, Sharad; Moran, Meena S.

doi:10.1016/j.ijrobp.2012.03.068

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…For example, a retrospective review of 246 patients with DCIS undergoing BCT between 2001 and 2007 at Harvard University demonstrated a 0% rate of IBTR with 58 months of follow-up 30 . Similar findings were noted by Nelson et al when evaluating a modern cohort of 609 patients with 10 year local recurrence rates of only 4.2–7.2% 31 . In summary, patients undergoing BCS with the addition of adjuvant RT have 10 year rates of IBTR of 10–15% based on older series (retrospective and prospective studies) and 0–7% based on more recent data.…”

Section: Resultssupporting

confidence: 86%

Ductal Carcinoma In Situ of the Breast

Shah

Vicini

Berry

et al. 2015

American Journal of Clinical Oncology

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Ductal carcinoma in-situ (DCIS) of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with DCIS include mastectomy or breast-conserving therapy (BCT). While several randomized trials have confirmed a greater than 50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared to breast-conserving surgery (BCS) alone, controversy persists regarding whether or not RT is needed in selected ‘low-risk’ patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery alone is associated with higher rates of local recurrence even after selecting patients with the most optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in these low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead employing more modern approaches such as multi-gene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multi-gene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of radiation therapy.

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Section: Resultssupporting

confidence: 86%

Ductal Carcinoma In Situ of the Breast

Shah

Vicini

Berry

et al. 2015

American Journal of Clinical Oncology

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“…This difference was no longer statistically significant after adjustment for pathologic variables [13, 16, 18]. Thus, the worse outcome among black DCIS patients may be attributable to more aggressive tumor pathology [24].…”

Section: Discussionmentioning

confidence: 99%

“…Prompt initiation and completion of adjuvant therapy are also important for breast cancer patients with BCS to lower their risks of local recurrence and mortality [39–41]. Studies reported no racial difference in surgical margins or receipt of hormone therapy in DCIS patients [13, 14, 16, 42, 43]. However, black race was associated with longer waiting time for and lower probabilities of completing radiotherapy following BCS [40, 41].…”

Section: Discussionmentioning

confidence: 99%

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Racial disparities in risk of second breast tumors after ductal carcinoma in situ

Liu

Colditz

Gehlert

et al. 2014

Breast Cancer Res Treat

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The purpose of the study was to examine the impact of race/ethnicity on second breast tumors among women with ductal carcinoma in situ (DCIS). We identified 102,489 women diagnosed with primary DCIS between 1988 and 2009 from the 18 NCI-SEER Registries. Cox proportional hazard regression was used to estimate race/ethnicity-associated relative risks (RRs) and their 95 % confidence intervals (CI) of ipsilateral breast tumors (IBT; defined as DCIS or invasive carcinoma in the ipsilateral breast) and contralateral breast tumors (CBT; defined as DCIS or invasive carcinoma in the contralateral breast). Overall, 2,925 women had IBT and 3,723 had CBT. Compared with white women, black (RR 1.46; 95 % CI 1.29–1.65), and Hispanic (RR 1.18; 95 % CI 1.03–1.36) women had higher IBT risk, which was similar for invasive IBT and ipsilateral DCIS. A significant increase in IBT risk among black women persisted, regardless of age at diagnosis, treatment, tumor grade, tumor size, and histology. The CBT risk was significantly increased among black (RR 1.21; 95 % CI 1.08–1.36) and Asian/PI (RR 1.16; 95 % CI 1.02–1.31) women compared with white women. The association was stronger for invasive CBT among black women and for contralateral DCIS among Asian/PI women (Pheterogeneity <0.0001). The black race-associated CBT risk was more pronounced among women ≥50 years at diagnosis and those with comedo DCIS; in contrast, a significant increase in risk among Asian/PI women was restricted to those <50 years and those with noncomedo DCIS. Racial/ethnic differences in risks of second breast tumors after DCIS could not be explained by pathologic features and treatment.

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“…With treatment, less than 2% of women with DCIS will die from breast cancer in the decade after diagnosis [4]. However, the presence of DCIS reflects increased risk for invasive breast cancer, as 11–19% of women with DCIS develop a second breast cancer within 10 years of diagnosis [5, 6], with similar rates 10 or more years after diagnosis [7]. …”

Section: Introductionmentioning

confidence: 99%

Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race

Madubata

Liu

Goodman

et al. 2016

Breast Cancer Res Treat

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Purpose To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS). Patients and Methods The analysis included 8,184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral and contralateral breast tumors for race. Results There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95% CI 0.99–1.35) or endocrine therapy (OR 1.19; 95% CI 0.94–1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95% CI 0.92–1.42), Black women had higher odds of radiation delay, defined as at least eight weeks between surgery and radiation (OR 1.92; 95% CI 1.55–2.37). Among 9,138 patients, 184 had ipsilateral breast tumors (IBTs) and 326 had contralateral breast tumors (CBTs). Black women had a higher risk of IBTs (HR 1.69; 95% CI 1.15–2.50) and a comparable risk of CBTs (HR 1.19; 95% CI 0.84–1.68), which were independent of pathological features and treatment. Conclusion Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.

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Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

Cited by 8 publications

References 16 publications

Ductal Carcinoma In Situ of the Breast

Ductal Carcinoma In Situ of the Breast

Racial disparities in risk of second breast tumors after ductal carcinoma in situ

Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race

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