Time-varying risks of second events following a DCIS diagnosis in the population-based Vermont DCIS cohort
- 85 Downloads
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.
KeywordsBreast cancer Ductal carcinoma in situ Treatment outcome Cohort studies Disease-free survival
Ductal carcinoma in situ
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.
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.
- 1.Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin K (2018) SEER cancer statistics review, 1975–2015. National Cancer Institute. https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018, Bethesda, MD
- 2.National Comprehensive Cancer Network (2018) NCCN Clinical practice guidelines in oncology: breast cancer. V.1.2018. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf
- 6.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 (41):162–177Google Scholar
- 7.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(6):478–488CrossRefGoogle Scholar
- 8.Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, Forbes JF, Bishop H, Fentiman IS, George WD (2011) 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 12(1):21–29CrossRefGoogle Scholar
- 12.Donker M, Litiere S, Werutsky G, Julien JP, Fentiman IS, Agresti R, Rouanet P, de Lara CT, Bartelink H, Duez N, Rutgers EJ, Bijker N (2013) 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 31(32):4054–4059CrossRefGoogle Scholar
- 13.Elshof LE, Schaapveld M, Schmidt MK, Rutgers EJ, van Leeuwen FE, Wesseling J (2016) Subsequent risk of ipsilateral and contralateral invasive breast cancer after treatment for ductal carcinoma in situ: incidence and the effect of radiotherapy in a population-based cohort of 10,090 women. Breast Cancer Res Treat 159(3):553–563CrossRefGoogle Scholar
- 15.Lehman CD, Arao RF, Sprague BL, Lee JM, Buist DS, Kerlikowske K, Henderson LM, Onega T, Tosteson AN, Rauscher GH, Miglioretti DL (2017) National performance benchmarks for modern screening digital mammography: update from the breast cancer surveillance consortium. Radiology 283(1):49–58CrossRefGoogle Scholar
- 16.American College of Radiology (2013) ACR BI-RADS® - Mammography. In: ACR BI-RADS Atlas: breast imaging reporting and data system, 5th edn. American College of Radiology, RestonGoogle Scholar
- 17.Fleiss JL (1981) Statistical methods for rates and proportions. Wiley, New YorkGoogle Scholar
- 18.Warnberg F, Garmo H, Emdin S, Hedberg V, Adwall L, Sandelin K, Ringberg A, Karlsson P, Arnesson LG, Anderson H, Jirstrom K, Holmberg L (2014) Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol 32(32):3613–3618CrossRefGoogle Scholar
- 19.Allred DC, Anderson SJ, Paik S, Wickerham DL, Nagtegaal ID, Swain SM, Mamounas EP, Julian TB, Geyer CE Jr, Costantino JP, Land SR, Wolmark N (2012) 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 30(12):1268–1273CrossRefGoogle Scholar
- 20.Burstein HJ, Temin S, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Rowden D, Solky AJ, Stearns V, Winer EP, Griggs JJ (2014) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol 32(21):2255–2269CrossRefGoogle Scholar