Variation in the management of ductal carcinoma in situ in the UK: Results of the Mammary Fold National Practice Survey

Ashken, L.; Ives, Charlotte; Kim, Baek; Potter, Shelley; Rattay, Tim; Remoundos, Dennis; Zeidan, Bashar; Williams, Kathryn E; Bathla, Sonia; Fatayer, Hiba; Sirianni, Chiara; Khan, Shahab; Hignett, S.; Rathinaezhil, Rathinasabapathy; Thomas, Hasler; Isherwood, Jenny; Topps, Ashley; Waterworth, Alison; Glassman, Deanna; Hunt, Richard; Mazari, Fayyaz; McEvoy, K; Hoar, Fiona; Graja, T.; Youssef, Mina; Turner, Emma; Johnson, R.J.; Kallaway, Charlotte; Almerie, Muhammad Qutayba; Cocker, Daniel; O’Brien, James; Saha, Sunita; Westbroek, David; Lee, C.; Frank, Lucinda; Segaran, Ashvina; Elfadl, Dalia; Ralph, Jane; MacInnes, Emma; Jones, Robin M.; Crosbie,; Foulkes, Rhiannon; Chand, Natalie; Khan, A; Ledwidge, Serena; Tang, Sarah; Ismail, Wesam W; Hamilton-Burke, Werbena; Singh, Jagdeep; Aggarwal, Shweta; Irwin, GW; Khan, Maria; Wild, John Benjamin; Jones, Louise; Venn, Mary L; Thrush, Steven; Tafazal, Habib; Parker, Jody; Baker, Elizabeth A.

doi:10.1016/j.ejso.2016.05.024

Cited by 15 publications

(6 citation statements)

References 28 publications

(27 reference statements)

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“…Besides positive excision margins, other risk factors for recurrence after BCS are tumour grade and size; patients with higher grade and/or larger DCIS appear at higher risk of developing IBC or recurrent DCIS after lumpectomy [22,23]. A recent UK-wide survey found these are the two most common factors in decision-making for adjuvant radiotherapy (in 51.3 and 35.5% of sites surveyed, respectively [24]). Additional independent predictors of progression or recurrence are younger patient age, micropapillary architecture and the presence of comedonecrosis [23,[25][26][27][28], as well as African-American race and strong family history of breast cancer or BRCA1/2 mutation [27].…”

Section: Adjuvant Therapymentioning

confidence: 99%

“…In short, the VNPI has not been shown unequivocally to be of clinical utility and this has hindered its acceptance into clinical practice. The use of this tool has also lacked support in the UK [50], with a recent survey revealing that only 15.8% of breast units across the country use it routinely and even in these sites there is a lack of consistency in the scores applied in the decision-making process [24]. Table 1).…”

Section: Challenges In the Management Of Dcis: The Need For Predictivmentioning

confidence: 99%

“…Indeed, a recent study found no treatment strategies incorporating this test are cost-effective [111]. A recent UK-based survey studying trends in DCIS management found only 1 site out of the 76 surveyed used this test routinely [24]. Additionally, like all other Oncotype assays, the DS test needs to be shipped to a central laboratory for processing and analysis, adding logistical constraints in countries outside the US.…”

Section: Challenges In the Management Of Dcis: The Need For Predictivmentioning

confidence: 99%

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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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Section: Adjuvant Therapymentioning

confidence: 99%

Section: Challenges In the Management Of Dcis: The Need For Predictivmentioning

confidence: 99%

Section: Challenges In the Management Of Dcis: The Need For Predictivmentioning

confidence: 99%

See 1 more Smart Citation

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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“…It is anticipated that the majority of the 144 breast units in the UK will offer TM to their patients. Based on experience from the iBRA study [26] and other trainee collaborative projects [20], approximately 40% of units will choose to participate in the study. It is therefore anticipated that between 250 and 500 patients will be recruited to the study from approximately 50 centres over a six month period.…”

Section: Methods and Analysismentioning

confidence: 99%

“…[17], [18], [19] and MasDA (Mastectomy Decisions Audit) and the development of a national breast surgical research collaborative [20] have demonstrated that the methodology is both feasible and effective within the context of breast surgery. It is anticipated that this network of highly-motivated breast and plastic surgical trainees and consultants can be utilised to deliver a new study to determine the practice and outcomes of therapeutic mammaplasty in the UK.…”

Section: Introductionmentioning

confidence: 99%

The TeaM ( T h e r a peutic M ammaplasty) study: Protocol for a prospective multi-centre cohort study to evaluate the practice and outcomes of therapeutic mammaplasty

Baker

Kim

Rattay

et al. 2016

International Journal of Surgery Protocols

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HighlightsMulticentre prospective study involving breast and plastic surgical units across the UK.Will produce valuable data regarding the practice and outcomes of therapeutic mammaplasty.Will inform decision-making and lead to future definitive study.Will strengthen the collaborative network to facilitate the delivery of future projects.Will increase awareness of the techniques among trainees such that participation is educational.

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Effect of preoperative injection of superparamagnetic iron oxide particles on rates of sentinel lymph node dissection in women undergoing surgery for ductal carcinoma in situ (SentiNot study)

Karakatsanis

Hersi

Pistioli

et al. 2019

British Journal of Surgery

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Background: One-fifth of patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) have invasive breast cancer (IBC) on definitive histology. Sentinel lymph node dissection (SLND) is performed in almost half of women having surgery for DCIS in Sweden. The aim of the present study was to try to minimize unnecessary SLND by injecting superparamagnetic iron oxide (SPIO) nanoparticles at the time of primary breast surgery, enabling SLND to be performed later, if IBC is found in the primary specimen.Methods: Women with DCIS at high risk for the presence of invasion undergoing breast conservation, and patients with DCIS undergoing mastectomy were included. The primary outcome was whether this technique could reduce SLND. Secondary outcomes were number of SLNDs avoided, detection rate and procedure-related costs.Results: This was a preplanned interim analysis of 189 procedures. IBC was found in 47 and a secondary SLND was performed in 41 women. Thus, 78⋅3 per cent of patients avoided SLND (P < 0⋅001). At reoperation, SPIO plus blue dye outperformed isotope and blue dye in detection of the sentinel node (40 of 40 versus 26 of 40 women; P < 0⋅001). Costs were reduced by a mean of 24⋅5 per cent in women without IBC (€3990 versus 5286; P < 0⋅001).Conclusion: Marking the sentinel node with SPIO in women having surgery for DCIS was effective at avoiding unnecessary SLND in this study. Registration number: ISRCTN18430240

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Variation in the management of ductal carcinoma in situ in the UK: Results of the Mammary Fold National Practice Survey

Abstract: General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms

Cited by 15 publications

References 28 publications

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

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

The TeaM ( T h e r a peutic M ammaplasty) study: Protocol for a prospective multi-centre cohort study to evaluate the practice and outcomes of therapeutic mammaplasty

Effect of preoperative injection of superparamagnetic iron oxide particles on rates of sentinel lymph node dissection in women undergoing surgery for ductal carcinoma in situ (SentiNot study)

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