Radiotherapy after mastectomy for screen-detected ductal carcinoma in situ

Clements, Karen; Dodwell, David; Lawrence, Gill; Ball, Graham; Francis, Adele; Pinder, Sarah; Sawyer, Elinor J.; Wallis, Matthew; Thompson, Alastair

doi:10.1016/j.ejso.2015.07.021

Cited by 24 publications

(23 citation statements)

References 14 publications

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“…In addition, available data include the use of endocrine therapy with linkage to outcomes. [2,3] Conversely, one limitation of the present study, in keeping with the recently published retrospective series [2][3][4]12] is its observational nature with the consequent difficulty in accounting for all possible confounders. Follow up is also relatively short in the context of the long natural history of DCIS.…”

Section: Discussionmentioning

confidence: 91%

“…The present prospective cohort study contrasts with recent but retrospective studies of US [2,3] and European data. [12] Unlike those series, we report prospectively collected data from the setting of an established national breast screening programme, with built in quality assurance of imaging, surgery, pathology and RT. [10,13] An additional major strength, in contrast to other studies including the randomised clinical trials, is the prospective collection of margin status, an area of significant international controversy.…”

Section: Discussionmentioning

confidence: 99%

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

Thompson

Clements

Cheung

et al. 2018

European Journal of Cancer

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Thompson

Clements

Cheung

et al. 2018

European Journal of Cancer

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“…More recent results suggest that factors such as close margins, large lesion size and microinvasion may be sufficient to consider RT following mastectomy for DCIS to reduce the risk of ipsilateral recurrence [135]. However, the risk of recurrence is small even in patients who did not receive RT, so the benefit of radiation may be limited.…”

Section: A Uk-wide Prospective Audit Of Dcis: the Sloane Projectmentioning

confidence: 99%

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast

Martínez-Pérez

Turnbull

Ekatah

et al. 2017

Cancer Treatment Reviews

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Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient.

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“…LRR after mastectomy for DCIS has historically been demonstrated as low, with the UK SLOANE audit reporting a 1% LRR,13 and a meta-analysis incorporating 1574 patients demonstrating an LRR of 1.4% 14. DCIS is associated with less clinically apparent disease, making identification of lesions intraoperatively more difficult 1.…”

mentioning

confidence: 99%

“…In 2007, 27% of patients undergoing a mastectomy for DCIS had an SSM with immediate breast reconstruction compared with 10% in invasive disease 3. The higher rates of SSM use in DCIS are to be expected as these patients are unlikely to require adjuvant radiotherapy 13. Despite SSMs increasing use in DCIS, there are little data on oncological outcomes in simple mastectomy compared with SSM.…”

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confidence: 99%

Comparison of Local Recurrence After Simple and Skin-Sparing Mastectomy Performed in Patients with Ductal Carcinoma In Situ

et al. 2016

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BackgroundThe incidence of ductal carcinoma in situ (DCIS) is increasing with the use of screening mammography, and approximately 30% of all women diagnosed with DCIS are treated by mastectomy. There is increasing use of a skin-sparing mastectomy (SSM) approach to surgically excise DCIS as this facilitates immediate breast reconstruction. The rates of locoregional recurrence (LRR) after simple mastectomy performed for pure DCIS are historically reported as 1%; however, international data suggest that LRR after SSM may be higher.MethodsTo determine our rates of LRR and compare the effect of the type of mastectomy performed, we undertook a retrospective review of all patients who underwent a mastectomy for pure DCIS at our institution between 2000 and 2010. ResultsIn total, 199 patients underwent a mastectomy for pure DCIS (with eight local recurrences), all of which were invasive ductal carcinoma. The recurrences all occurred after SSM, which was associated with a higher 5-year LRR of 5.9% (5/102) compared with 0% in the simple mastectomy group (0/97; p = 0.012), log-rank. Univariate analysis showed the two factors that predicted the risk of recurrence were a young age at mastectomy and close or involved margins.ConclusionsThese data highlight the importance of achieving clear margins, especially in young women with estrogen receptor-negative DCIS who have a higher risk of invasive recurrence. Women undergoing a mastectomy for DCIS should be counseled as to the importance of achieving clear margins and the potential increased need for further excision, post-mastectomy radiotherapy and post-reconstruction mammography in order to prevent LRR after SSM.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5673-6) contains supplementary material, which is available to authorized users.

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Radiotherapy after mastectomy for screen-detected ductal carcinoma in situ

Abstract: Background. A role for radiotherapy after mastectomy for ductal carcinoma in situ (DCIS) is unclear. Using a prospective audit of DCIS detected through the NHS Breast Screening Programme we sought to determine a rationale for the use of postmastectomy radiotherapy for DCIS.

Cited by 24 publications

References 14 publications

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

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

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast

Comparison of Local Recurrence After Simple and Skin-Sparing Mastectomy Performed in Patients with Ductal Carcinoma In Situ

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