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Second events following ductal carcinoma in situ of the breast: a register-based cohort study

  • Ragnhild Sørum Falk
  • Solveig Hofvind
  • Per Skaane
  • Tor Haldorsen
Epidemiology

Abstract

The incidence of ductal carcinoma in situ (DCIS) of the breast has increased in recent decades, particularly, in counties offering mammography screening. The aims of the present study are to examine factors that may predict subsequent breast malignancy amongst patients with DCIS, and to compare the incidence of the subsequent malignancy and mortality with that of the general population. This population-based study includes all primary cases of pure DCIS diagnosed in Norway in the period 1993 to 2007 (N = 3167). The patients were followed to subsequent malignancy (DCIS or invasive cancer) or death. Risk estimates within 10 years of follow-up were calculated using Kaplan–Meier methods adjusting for competing risks, Cox regression models and Standard Incidence and Mortality Ratios. Patients with DCIS had a 11.2% risk of being diagnosed with a subsequent breast malignancy within 10 years (9.4% for invasive cancer), implying that they were five times as likely to be diagnosed with breast malignancy as the general female population in Norway. The risk was dependent on the treatment of the DCIS; patients treated with mastectomy and breast-conserving treatment had a 3.8 and 9.8% risk of ipsilateral invasive cancer within 10 years, respectively. Breast cancer mortality was 2.5% within 10 years of follow-up, a fourfold risk compared with the general population. Patients with DCIS have an increased risk of both subsequent breast malignancy and breast cancer death compared with women in the general population. Our results support previous knowledge of DCIS as a heterogeneous disease.

Keywords

Breast cancer Ductal carcinoma in situ Mammography screening Mortality Second malignancy Treatment 

Notes

Acknowledgments

The study was funded by South-Eastern Norway Regional Health Authority (Grant No. 3b-110), which has not had any further influence on the study.

Conflict of interest statement

None declared.

References

  1. 1.
    van Steenbergen LN, Voogd AC, Roukema JA, Louwman WJ, Duijm LE, Coebergh JW, van de Poll-Franse LV (2009) Screening caused rising incidence rates of ductal carcinoma in situ of the breast. Breast Cancer Res Treat 115:181–183PubMedCrossRefGoogle Scholar
  2. 2.
    Virnig BA, Tuttle TM, Shamliyan T, Kane RL (2010) Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 102:170–178PubMedCrossRefGoogle Scholar
  3. 3.
    Sørum R, Hofvind S, Skaane P, Haldorsen T (2010) Trends in incidence of ductal carcinoma in situ: the effect of a population-based screening programme. Breast 19:499–505PubMedCrossRefGoogle Scholar
  4. 4.
    Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM (2004) Ductal carcinoma in situ of the breast. N Engl J Med 350:1430–1441PubMedCrossRefGoogle Scholar
  5. 5.
    Leonard GD, Swain SM (2004) Ductal carcinoma in situ, complexities and challenges. J Natl Cancer Inst 96:906–920PubMedCrossRefGoogle Scholar
  6. 6.
    Patani N, Cutuli B, Mokbel K (2008) Current management of DCIS: a review. Breast Cancer Res Treat 111:1–10PubMedCrossRefGoogle Scholar
  7. 7.
    Pinder SE (2010) Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation. Mod Pathol 23(Suppl 2):S8–S13PubMedCrossRefGoogle Scholar
  8. 8.
    Bombonati A, Sgroi DC (2011) The molecular pathology of breast cancer progression. J Pathol 223:307–317PubMedCrossRefGoogle Scholar
  9. 9.
    Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N (2001) Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the National Surgical Adjuvant Breast and Bowel Project experience. Semin Oncol 28:400–418PubMedCrossRefGoogle Scholar
  10. 10.
    Romero L, Klein L, Ye W, Holmes D, Soni R, Silberman H, Lagios MD, Silverstein MJ (2004) Outcome after invasive recurrence in patients with ductal carcinoma in situ of the breast. Am J Surg 188:371–376PubMedCrossRefGoogle Scholar
  11. 11.
    Godat LN, Horton JK, Shen P, Stewart JH, Wentworth S, Levine EA (2009) Recurrence after mastectomy for ductal carcinoma in situ. Am Surg 75:592–595PubMedGoogle Scholar
  12. 12.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, Peto R, Bijker N, Solin L, Darby S (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010:162–177PubMedCrossRefGoogle Scholar
  13. 13.
    Innos K, Horn-Ross PL (2008) Risk of second primary breast cancers among women with ductal carcinoma in situ of the breast. Breast Cancer Res Treat 111:531–540PubMedCrossRefGoogle Scholar
  14. 14.
    Habel LA, Moe RE, Daling JR, Holte S, Rossing MA, Weiss NS (1997) Risk of contralateral breast cancer among women with carcinoma in situ of the breast. Ann Surg 225:69–75PubMedCrossRefGoogle Scholar
  15. 15.
    Claus EB, Stowe M, Carter D, Holford T (2003) 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 12:451–456PubMedCrossRefGoogle Scholar
  16. 16.
    Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA, Schwartz AM, Slomski C, Yothers G, Zon R (2009) NIH state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ (DCIS). NIH Consens State Sci Statements 26:1–27PubMedGoogle Scholar
  17. 17.
    Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, Wolmark N (1999) Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer 86:429–438PubMedCrossRefGoogle Scholar
  18. 18.
    Shamliyan T, Wang SY, Virnig BA, Tuttle TM, Kane RL (2010) Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ. J Natl Cancer Inst Monogr 2010:121–129PubMedCrossRefGoogle Scholar
  19. 19.
    Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R (2000) Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med 160:953–958PubMedCrossRefGoogle Scholar
  20. 20.
    Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, Gennaro M, Rouanet P, Avril A, Fentiman IS, Bartelink H, Rutgers EJ (2006) 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 24:3381–3387PubMedCrossRefGoogle Scholar
  21. 21.
    Kerlikowske K, Molinaro A, Cha I, Ljung BM, Ernster VL, Stewart K, Chew K, Moore DH, Waldman F (2003) Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy. J Natl Cancer Inst 95:1692–1702PubMedGoogle Scholar
  22. 22.
    Ji J, Hemminki K (2007) Risk for contralateral breast cancers in a population covered by mammography: effects of family history, age at diagnosis and histology. Breast Cancer Res Treat 105:229–236PubMedCrossRefGoogle Scholar
  23. 23.
    Larsen IK, Smastuen M, Johannesen TB, Langmark F, Parkin DM, Bray F, Moller B (2009) Data quality at the Cancer Registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur J Cancer 45:1218–1231PubMedCrossRefGoogle Scholar
  24. 24.
    Pintilie M (2006) Competing risks: a practical perspective. Wiley, ChichesterGoogle Scholar
  25. 25.
    Pintilie M (2002) Dealing with competing risks: testing covariates and calculating sample size. Stat Med 21:3317–3324PubMedCrossRefGoogle Scholar
  26. 26.
    Levi F, Randimbison L, Te VC, La Vecchia C (2005) Invasive breast cancer following ductal and lobular carcinoma in situ of the breast. Int J Cancer 116:820–823PubMedCrossRefGoogle Scholar
  27. 27.
    Li CI, Malone KE, Saltzman BS, Daling JR (2006) Risk of invasive breast carcinoma among women diagnosed with ductal carcinoma in situ and lobular carcinoma in situ, 1988–2001. Cancer 106:2104–2112PubMedCrossRefGoogle Scholar
  28. 28.
    Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, Land SR, Margolese RG, Swain SM, Costantino JP, Wolmark N (2011) 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 103:478–488PubMedCrossRefGoogle Scholar
  29. 29.
    Provenzano E, Pinder SE (2009) Pre-operative diagnosis of breast cancer in screening: problems and pitfalls. Pathology (Phila) 41:3–17Google Scholar
  30. 30.
    Lagios MD, Westdahl PR, Margolin FR, Rose MR (1982) Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 50:1309–1314PubMedCrossRefGoogle Scholar
  31. 31.
    Rakovitch E, Pignol JP, Hanna W, Narod S, Spayne J, Nofech-Mozes S, Chartier C, Paszat L (2007) Significance of multifocality in ductal carcinoma in situ: outcomes of women treated with breast-conserving therapy. J Clin Oncol 25:5591–5596PubMedCrossRefGoogle Scholar
  32. 32.
    Tot T (2005) DCIS, cytokeratins, and the theory of the sick lobe. Virchows Arch 447:1–8PubMedCrossRefGoogle Scholar
  33. 33.
    Holmberg L, Duffy SW, Yen AM, Tabár L, Vitak B, Nyström L, Frisell J (2009) Differences in endpoints between the Swedish W-E (two county) trial of mammographic screening and the Swedish overview: methodological consequences. J Med Screen 16:73–80PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Ragnhild Sørum Falk
    • 1
  • Solveig Hofvind
    • 1
    • 2
  • Per Skaane
    • 3
  • Tor Haldorsen
    • 1
  1. 1.Department of Screening-Based ResearchCancer Registry of NorwayOslo, MajorstuenNorway
  2. 2.Faculty of Health SciencesOslo University CollegeOsloNorway
  3. 3.Department of RadiologyOslo University Hospital Ullevaal, University of OsloOsloNorway

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