Breast Cancer Research and Treatment

, Volume 174, Issue 1, pp 227–235 | Cite as

Time-varying risks of second events following a DCIS diagnosis in the population-based Vermont DCIS cohort

  • Brian L. SpragueEmail author
  • Pamela M. Vacek
  • Sally D. Herschorn
  • Ted A. James
  • Berta M. Geller
  • Amy Trentham-Dietz
  • Janet L. Stein
  • Donald L. Weaver



Long-term disease-free survival patterns following surgical, radiation, and endocrine therapy treatments for ductal carcinoma in situ (DCIS) are not well characterized in general US practice.


We identified 1252 women diagnosed with DCIS in Vermont during 1994–2012 using data from the Vermont Breast Cancer Surveillance System, a statewide registry of breast imaging and pathology records. Poisson regression and Cox regression with time-varying hazards were used to evaluate disease-free survival among self-selected treatment groups.


With 7.8 years median follow-up, 192 cases experienced a second breast cancer diagnosis. For women treated with breast-conserving surgery (BCS) alone, the annual rate of second events decreased from 3.1% (95% CI 2.2–4.2%) during follow-up years 1–5 to 1.7% (95% CI 0.7–3.5%) after 10 years. In contrast, the annual rate of second events among women treated with BCS plus adjuvant radiation therapy increased from 1.8% (95% CI 1.1–2.6%) during years 1–5 to 2.8% (95% CI 1.6–4.7%) after 10 years (P < 0.05 for difference in trend compared to BCS alone). Annual rates of second events also increased over time among women treated with BCS plus adjuvant radiation and endocrine therapy (P = 0.01 for difference in trend compared to BCS alone). The rate of contralateral events increased after 10 years for all groups with adjuvant treatments. The rate of second events did not vary over time among women who underwent ipsilateral mastectomy (P = 0.62).


Long-term risk of a second event after DCIS varies over time in a manner dependent on initial treatment.


Breast cancer Ductal carcinoma in situ Treatment outcome Cohort studies Disease-free survival 



Breast-conserving surgery


Confidence interval


Ductal carcinoma in situ


Estrogen receptor


Endocrine therapy


Radiation therapy


Vermont Breast Cancer Surveillance System


Vermont Cancer Registry



This work was supported by the National Cancer Institute (U01 CA196383, U54 CA163303, P01 CA154292), the Patient-Centered Outcomes Research Institute (PCS-1504-30370), and the University of Vermont Cancer Center with funds generously awarded by the Lake Champlain Cancer Research Organization (pilot grant #032800). The collection of Vermont Cancer Registry data used in this study was supported by Cooperative Agreement No. NU58DP006322 from the Centers for Disease Control and Prevention. The statements presented in this work are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, the Centers for Disease Control and Prevention, or PCORI, its Board of Governors or Methodology Committee. The authors wish to thank Drs. Andrew Goodwin, Brenda Waters, and Jill Warrington who participated in the centralized review of DCIS specimens; Alison Johnson and Jennifer Kachajian at the Vermont Cancer Registry; and Mark Bowman, Mike Butler, Rachael Chicoine, Meghan Farrington, Cindy Groseclose, Kathleen Howe, Dr. John Mace, Denis Nunez, Dawn Pelkey, Dusty Quick, and Tiffany Sharp of the Vermont Breast Cancer Surveillance System.

Compliance with ethical standards

Conflict of interest

None of the authors have a financial relationship with any of the organizations that sponsored the research.

Ethical approval

All procedures in this study comply with the current laws of the USA. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of VermontBurlingtonUSA
  2. 2.Department of RadiologyUniversity of VermontBurlingtonUSA
  3. 3.University of Vermont Cancer CenterUniversity of VermontBurlingtonUSA
  4. 4.Medical Biostatistics UnitUniversity of VermontBurlingtonUSA
  5. 5.Department of Surgery, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  6. 6.Department of Family MedicineUniversity of VermontBurlingtonUSA
  7. 7.Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin Carbone Cancer CenterUniversity of Wisconsin-MadisonMadisonUSA
  8. 8.Department of BiochemistryUniversity of VermontBurlingtonUSA
  9. 9.Department of PathologyUniversity of VermontBurlingtonUSA

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