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Impact of microinvasion on breast cancer mortality in women with ductal carcinoma in situ

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 20 August 2019

Abstract

Background

Ductal carcinoma in situ (DCIS) is a neoplastic proliferation of epithelial cells which is confined within the basement membrane of the mammary ductal–lobular system. It is of interest to determine to what extent the potential to metastasize increases for DCIS patients when the basement membrane is breached (i.e. microinvasion is present).

Methods

We retrieved the records of 525,395 women who had either first primary DCIS or small (≤ 2.0 cm) node-negative invasive breast cancer in the Surveillance, Epidemiology and End Results (SEER) registries database (1990–2013). For each patient, we extracted information on year of diagnosis, age at diagnosis, tumour size, tumour grade, oestrogen receptor status, use of radiotherapy, type of surgery, cause of death and follow-up time. We classified patients into four groups, according to the size of the invasive component of the primary tumour. We estimated the actuarial rate of breast cancer-specific mortality at ten and 20 years for women in each size category.

Results

We identified 161,394 women with pure DCIS, 13,489 women with microinvasive carcinoma (≤ 0.1 cm of invasion), 153,856 women with invasive cancer 0.2–1.0 cm in size and 196,656 women with invasive cancer 1.1–2.0 cm in size. The 20-year actuarial breast cancer-specific mortality rate was 3.8% for women with pure DCIS, was 6.9% for women with microinvasive carcinoma, was 6.8% for women with invasive cancer 0.2–1.0 cm in size and was 12.1% for women with invasive cancer 1.1–2.0 cm in size. The adjusted hazard ratio for death associated with microinvasive carcinoma (vs. pure DCIS) was 2.00 (95% CI 1.76–2.26; p < 0.0001).

Conclusions

In terms of prognosis, microinvasive cancer more closely resembles small invasive cancer 0.2–1.0 cm) than pure DCIS. For invasive cancers under 1.0 cm, size has little impact on mortality.

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Authors and Affiliations

  1. Women’s College Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B1, Canada

    Victoria Sopik, Ping Sun & Steven A. Narod

  2. Institute of Medical Science, University of Toronto, Toronto, Canada

    Victoria Sopik

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Steven A. Narod

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  1. Victoria Sopik
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  2. Ping Sun
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Correspondence to Steven A. Narod.

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Sopik, V., Sun, P. & Narod, S.A. Impact of microinvasion on breast cancer mortality in women with ductal carcinoma in situ. Breast Cancer Res Treat 167, 787–795 (2018). https://doi.org/10.1007/s10549-017-4572-2

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