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Annals of Surgical Oncology

, Volume 26, Issue 13, pp 4264–4271 | Cite as

Impact of Age on Locoregional and Distant Recurrence After Mastectomy for Ductal Carcinoma In Situ With or Without Microinvasion

  • Anita Mamtani
  • Faina Nakhlis
  • Stephanie Downs-Canner
  • Emily C. Zabor
  • Monica Morrow
  • Tari A. King
  • Kimberly J. Van ZeeEmail author
Breast Oncology

Abstract

Background

Locoregional recurrence (LRR) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is increased in young women. We examined the impact of age on LRR and distant disease after mastectomy for DCIS ± microinvasion.

Methods

We identified consecutive patients with DCIS ± microinvasion treated with mastectomy from 1995 to 2017. LRR was defined as recurrence at the ipsilateral chest wall or regional nodes.

Results

Overall, 3121 cases were identified, of which 421 (13.5%) had DCIS + microinvasion. Median age was 49 years and median follow-up was 6.4 years; 821 were followed for 10 or more years. Thirty-four LRRs were observed: 33 (97%) were invasive, and 23 (68%) were in the chest wall alone. Cumulative 10-year LRR incidence was 1.4%. Age < 50 years, high grade, and DCIS + microinvasion were associated with LRR (p ≤ 0.001); however, margin status was not (p = 0.14). Adjusting for grade and DCIS + microinvasion, age < 50 years (hazard ratio [HR] 14.7, 95% confidence interval [CI] 3.5–61.5; p < 0.001) was associated with LRR. Compared with women ≥ 50 years of age, women age < 40 years had the highest risk (HR 27.0, 95% CI 6.0–121), and women age 40–49 years had intermediate risk (HR 11.8, 95% CI 2.8–50.5). The cumulative 10-year LRR incidence was 4.2% for women < 40 years of age, 2.0% for women 40–49 years of age, and 0.2% for women ≥ 50 years of age. Women age < 40 years had a 10-year distant disease rate of 1.6% versus women age 40–49 years (0.7%) and women age ≥ 50 years (0.7%) (log-rank p = 0.051). Grade, DCIS + microinvasion, and margins were unassociated with distant disease.

Conclusions

LRR after mastectomy for DCIS ± microinvasion is uncommon, but is more frequent among women < 50 years of age, particularly in those < 40 years of age. The 10-year LRR rate in this youngest group remains low at 4.2%. Young age is an independent risk factor for LRR after BCS or mastectomy.

Notes

Funding

The preparation of this study was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748.

Disclosures

Monica Morrow and Tari A. King have received honoraria from Genomic Health and Roche. Kimberly J. Van Zee served on the advisory board of Genomic Health in 2012. Anita Mamtani, Faina Nakhlis, Stephanie Downs-Canner, and Emily C. Zabor have no conflicts of interest to declare.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Division of Breast Surgery, Department of SurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Biostatistics Service, Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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