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Biology, Treatment, and Outcome in Very Young and Older Women with DCIS

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study examines a modern cohort of women with ductal carcinoma-in-situ (DCIS) in order to identify potential differences in clinical presentation, treatments, and outcome based on age.

Methods

From 1996 to 2009, a total of 2037 patients with pure DCIS were treated. Clinical presentation, pathologic factors, type of surgery and adjuvant therapy, and local recurrence rates among age groups were compared and analyzed. Median follow-up was 5.2 years.

Results

There were 132 patients (6.5 %) aged <40, 1,690 (83 %) aged 40–70, and 215 (10.5 %) aged >70. Younger patients (<40) were significantly more likely to have a family history of breast cancer, present with clinical symptoms, undergo mastectomy with immediate reconstruction, and have a contralateral prophylactic mastectomy (P < 0.05). Older patients (>70) were significantly less likely to use adjuvant radiotherapy and tamoxifen (P < 0.05). No significant differences were found in DCIS size, estrogen receptor status, necrosis, or contralateral breast cancer based on age. Among women <40, 29.3 % had evidence of multicentric disease versus 17.7 and 13.3 % in the women aged 40–70 and those >70, respectively (P = 0.004). On multivariate analysis, younger age (<40), larger-size DCIS (≥1.5 cm), and no use of radiotherapy were significant independent predictors of locoregional recurrence. The 5 year rates of local recurrence were 10.1 % in women <40 compared with 3.2 % in older women (P = 0.005).

Conclusions

Younger patients with DCIS more often have multicentric disease, present with clinical findings, and opt for or require mastectomy with immediate reconstruction. Conservative surgery is only appropriate for younger patients if adjuvant radiotherapy is delivered.

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Acknowledgment

This research was supported by National Institutes of Health Grant, CA016672.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rosalinda Alvarado MD, Sara A. Lari BS, Robert E. Roses MD, Elizabeth A. Mittendorf MD, Anthony Lucci MD, Gildy V. Babiera MD, Jamie L. Wagner DO, Abigail S. Caudle MD, Funda Meric-Bernstam MD, Rosa F. Hwang MD, Isabelle Bedrosian MD, Kelly K. Hunt MD & Henry M. Kuerer MD, PhD, FACS

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Benjamin D. Smith MD

  3. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wei Yang MD

  4. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Banu K. Arun MD

Authors
  1. Rosalinda Alvarado MD
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  2. Sara A. Lari BS
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  3. Robert E. Roses MD
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  4. Benjamin D. Smith MD
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  5. Wei Yang MD
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  6. Elizabeth A. Mittendorf MD
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  8. Anthony Lucci MD
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  9. Gildy V. Babiera MD
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  10. Jamie L. Wagner DO
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  11. Abigail S. Caudle MD
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  13. Rosa F. Hwang MD
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  14. Isabelle Bedrosian MD
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  15. Kelly K. Hunt MD
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  16. Henry M. Kuerer MD, PhD, FACS
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Corresponding author

Correspondence to Henry M. Kuerer MD, PhD, FACS.

Additional information

Presented in part at the 65th Annual Cancer Symposium of the Society of Surgical Oncology, Orlando, FL, March 21–24, 2012.

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Alvarado, R., Lari, S.A., Roses, R.E. et al. Biology, Treatment, and Outcome in Very Young and Older Women with DCIS. Ann Surg Oncol 19, 3777–3784 (2012). https://doi.org/10.1245/s10434-012-2413-4

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  • DOI: https://doi.org/10.1245/s10434-012-2413-4

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