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Contralateral Breast Cancer Risk in Women with Ductal Carcinoma In Situ: Is it High Enough to Justify Bilateral Mastectomy?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Women with ductal carcinoma in situ (DCIS) are increasingly choosing bilateral mastectomy. We sought to quantify rates of contralateral breast cancer (CBC) and ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) for DCIS, and to compare risk factors for CBC and IBTR.

Methods

From 1978 to 2011, DCIS patients undergoing BCS with a contralateral breast at risk were identified from a prospectively maintained database. The association of clinicopathologic and treatment factors with CBC and IBTR were evaluated using Kaplan–Meier analysis, multivariable Cox regression, and competing risk regression (CRR).

Results

Of 2759 patients identified, 151 developed CBC and 344 developed IBTR. Five- and 10-year Kaplan–Meier CBC rates were 3.2 and 6.4%. Overall, 10-year IBTR rates were 2.5-fold higher than CBC rates, and, without radiation, 4-fold higher. On CRR, 5- and 10-year rates were 2.9 and 5.8% for CBC, and 7.8 and 14.5% for IBTR. CBC risk and invasive CBC risk were not significantly associated with age, family history, presentation, nuclear grade, year of surgery, or radiation. By multivariable Cox regression, endocrine therapy was associated with lower CBC risk (hazard ratio 0.57, p = 0.03). Ten-year risk of subsequent CBC in the subset of patients who developed IBTR was similar to the cohort as a whole (8.1 vs. 6.4%).

Conclusions

CBC rates were low across all groups, including those who experienced IBTR. CBC was not associated with factors that increase IBTR risk. While factors associated with IBTR risk are important in decision making regarding management of the index DCIS, they are not an indication for contralateral prophylactic mastectomy.

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References

  1. Steiner CA, Weiss AJ, Barrett ML, Fingar KR, Davis PH. Trends in bilateral and unilateral mastectomies in hospital inpatient and ambulatory settings, 2005-2013. Statistical Brief #201 (updated 1 Mar). Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb201-Mastectomies-Inpatient-Outpatient.jsp.

  2. Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998-2007. Ann Surg Oncol. 2010;17(10):2554–62.

    Article  PubMed  Google Scholar 

  3. Pesce CE, Liederbach E, Czechura T, Winchester DJ, Yao K. Changing surgical trends in young patients with early stage breast cancer, 2003 to 2010: a report from the National Cancer Data Base. J Am Coll Surg. 2014;219(1):19–28.

    Article  PubMed  Google Scholar 

  4. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.

    Article  PubMed  Google Scholar 

  5. Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1(7):888–96.

    Article  PubMed  Google Scholar 

  6. Worni M, Akushevich I, Greenup R, et al. Trends in treatment patterns and outcomes for ductal carcinoma in situ. J Natl Cancer Inst. 2015;107(12):djv263.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rakovitch E, Franssen E, Kim J, et al. A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat. 2003;77(3):285–93.

    Article  PubMed  Google Scholar 

  8. Abbott A, Rueth N, Pappas-Varco S, Kuntz K, Kerr E, Tuttle T. Perceptions of contralateral breast cancer: an overestimation of risk. Ann Surg Oncol. 2011;18(11):3129–36.

    Article  PubMed  Google Scholar 

  9. Partridge A, Adloff K, Blood E, et al. Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst. 2008;100(4):243-51.

    Article  PubMed  Google Scholar 

  10. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472):1687–717.

    Article  Google Scholar 

  11. Gao X, Fisher SG, Emami B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2003;56(4):1038–45.

    Article  PubMed  Google Scholar 

  12. Nichols HB, Berrington de Gonzalez A, Lacey JV Jr, Rosenberg PS, Anderson WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29(12):1564–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16(3):1141–54.

    Article  Google Scholar 

  14. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94(446):496–509.

    Article  Google Scholar 

  15. Ager B, Butow P, Jansen J, Phillips KA, Porter D. Contralateral prophylactic mastectomy (CPM): a systematic review of patient reported factors and psychological predictors influencing choice and satisfaction. Breast. 2016;28:107–20.

    Article  PubMed  Google Scholar 

  16. Covelli AM, Baxter NN, Fitch MI, McCready DR, Wright FC. ‘Taking control of cancer’: understanding women’s choice for mastectomy. Ann Surg Oncol. 2015;22(2):383–91.

    Article  PubMed  Google Scholar 

  17. Tracy MS, Rosenberg SM, Dominici L, Partridge AH. Contralateral prophylactic mastectomy in women with breast cancer: trends, predictors, and areas for future research. Breast Cancer Res Treat. 2013;140(3):447–52.

    Article  PubMed  Google Scholar 

  18. Yi M, Hunt KK, Arun BK, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res (Phila). 2010;3(8):1026–34.

    Article  Google Scholar 

  19. Claus EB, Stowe M, Carter D, Holford T. The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry. Breast. 2003;12(6):451–6.

    Article  PubMed  Google Scholar 

  20. Innos K, Horn-Ross PL. Risk of second primary breast cancers among women with ductal carcinoma in situ of the breast. Breast Cancer Res Treat. 2008;111(3):531–40.

    Article  PubMed  Google Scholar 

  21. Subhedar P, Olcese C, Patil S, Morrow M, Van Zee KJ. Decreasing recurrence rates for ductal carcinoma in situ: analysis of 2996 women treated with breast-conserving surgery over 30 years. Ann Surg Oncol. 2015;22(10):3273–81.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bernstein JL, Lapinski RH, Thakore SS, Doucette JT, Thompson WD. The descriptive epidemiology of second primary breast cancer. Epidemiology. 2003;14(5):552–8.

    Article  PubMed  Google Scholar 

  23. Bernstein JL, Thompson WD, Risch N, Holford TR. The genetic epidemiology of second primary breast cancer. Am J Epidemiol. 1992;136(8):937–48.

    Article  CAS  PubMed  Google Scholar 

  24. Reiner AS, John EM, Brooks JD, et al. Risk of asynchronous contralateral breast cancer in noncarriers of BRCA1 and BRCA2 mutations with a family history of breast cancer: a report from the Women’s Environmental Cancer and Radiation Epidemiology Study. J Clin Oncol. 2013;31(4):433–9.

    Article  PubMed  Google Scholar 

  25. Li CI, Malone KE, Saltzman BS, Daling JR. Risk of invasive breast carcinoma among women diagnosed with ductal carcinoma in situ and lobular carcinoma in situ, 1988-2001. Cancer. 2006;106(10):2104–12.

    Article  PubMed  Google Scholar 

  26. Cronin PA, Olcese C, Patil S, Morrow M, Van Zee KJ. Impact of age on risk of recurrence of ductal carcinoma in situ: outcomes of 2996 women treated with breast-conserving surgery over 30 years. Ann Surg Oncol. 2016;23(9):2816–24.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Flanagan MR, Rendi MH, Gadi VK, Calhoun KE, Gow KW, Javid SH. Adjuvant endocrine therapy in patients with ductal carcinoma in situ: a population-based retrospective analysis from 2005 to 2012 in the National Cancer Data Base. Ann Surg Oncol. 2015;22(10):3264–72.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Nichols HB, Bowles EJ, Islam J, et al. Tamoxifen initiation after ductal carcinoma in situ. Oncologist. 2016;21(2):134–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 2011;12(1):21–9.

    Article  CAS  PubMed  Google Scholar 

  30. Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bijker N, Meijnen P, Peterse JL, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853. A study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24(21):3381–7.

    Article  PubMed  Google Scholar 

  32. Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999;353(9169):1993–2000.

    Article  CAS  PubMed  Google Scholar 

  33. Ringberg A, Nordgren H, Thorstensson S, et al. Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast–results from the Swedish randomised trial. Eur J Cancer. 2007;43(2):291–8.

    Article  CAS  PubMed  Google Scholar 

  34. Rudloff U, Brogi E, Brockway JP, et al. Concurrent lobular neoplasia increases the risk of ipsilateral breast cancer recurrence in patients with ductal carcinoma in situ treated with breast-conserving therapy. Cancer. 2009;115(6):1203–14.

    Article  PubMed  Google Scholar 

  35. Van Zee KJ, Liberman L, Samli B, et al. Long term follow-up of women with ductal carcinoma in situ treated with breast-conserving surgery: the effect of age. Cancer. 1999;86(9):1757–67.

    Article  PubMed  Google Scholar 

  36. Vicini FA, Shaitelman S, Wilkinson JB, et al. Long-term impact of young age at diagnosis on treatment outcome and patterns of failure in patients with ductal carcinoma in situ treated with breast-conserving therapy. Breast J. 2013;19(4):365–73.

    Article  PubMed  Google Scholar 

  37. Allred DC, Anderson SJ, Paik S, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012;30(12):1268–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Donker M, Litiere S, Werutsky G, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. J Clin Oncol. 2013;31(32):4054–9.

    Article  PubMed  Google Scholar 

  39. Warnberg F, Garmo H, Emdin S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol. 2014;32(32):3613–8.

    Article  PubMed  Google Scholar 

  40. Crosby MA, Garvey PB, Selber JC, et al. Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg. 2011;128(5):1025–33.

    Article  CAS  PubMed  Google Scholar 

  41. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;(11):CD002748.

  42. Miller ME, Czechura T, Martz B, et al. Operative risks associated with contralateral prophylactic mastectomy: a single institution experience. Ann Surg Oncol. 2013;20(13):4113–20.

    Article  PubMed  Google Scholar 

  43. Silva AK, Lapin B, Yao KA, Song DH, Sisco M. The effect of contralateral prophylactic mastectomy on perioperative complications in women undergoing immediate breast reconstruction: a NSQIP analysis. Ann Surg Oncol. 2015;22(11):3474–80.

    Article  PubMed  Google Scholar 

  44. Altschuler A, Nekhlyudov L, Rolnick SJ, et al. Positive, negative, and disparate: women’s differing long-term psychosocial experiences of bilateral or contralateral prophylactic mastectomy. Breast J. 2008;14(1):25–32.

    Article  PubMed  Google Scholar 

  45. Frost MH, Hoskin TL, Hartmann LC, Degnim AC, Johnson JL, Boughey JC. Contralateral prophylactic mastectomy: long-term consistency of satisfaction and adverse effects and the significance of informed decision-making, quality of life, and personality traits. Ann Surg Oncol. 2011;18(11):3110–6.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–81.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

The preparation of this study was supported by National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

Disclosures

Megan E. Miller, Shirin Muhsen, Cristina Olcese, Sujata Patil, Monica Morrow, and Kimberly J. Van Zee have no conflicts of interest to declare.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Megan E. Miller MD, Shirin Muhsen MD, Cristina Olcese BS, Monica Morrow MD, FACS & Kimberly J. Van Zee MS, MD, FACS

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sujata Patil PhD

  3. Weill Medical College at Cornell University, 300 East 66th Street, New York, NY, USA

    Monica Morrow MD, FACS & Kimberly J. Van Zee MS, MD, FACS

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  1. Megan E. Miller MD
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  2. Shirin Muhsen MD
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Correspondence to Kimberly J. Van Zee MS, MD, FACS.

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Miller, M.E., Muhsen, S., Olcese, C. et al. Contralateral Breast Cancer Risk in Women with Ductal Carcinoma In Situ: Is it High Enough to Justify Bilateral Mastectomy?. Ann Surg Oncol 24, 2889–2897 (2017). https://doi.org/10.1245/s10434-017-5931-2

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  • DOI: https://doi.org/10.1245/s10434-017-5931-2

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