Skip to main content

Advertisement

SpringerLink
Log in

Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years

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

An Erratum to this article was published on 29 September 2015

Abstract

Background

Randomized trials of radiation after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) found substantial rates of recurrence, with half of the recurrences being invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed and are largely attributed to improvements in systemic therapy. In this study, we examine recurrence rates after BCS for DCIS over 3 decades at one institution.

Methods

We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010. Cox proportional hazard models were used to investigate the association between the treatment period and recurrence, controlling for other variables.

Results

Overall, 363 (12 %) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0–30 years); 732 patients were followed for ≥10 years. The 5-year recurrence rate for the period 1978–1998 was 13.6 versus 6.6 % for the period 1999–2010 [hazard ratio (HR) 0.62, p < 0.0001]. Controlling for age, family history, presentation, nuclear grade, necrosis, number of excisions, margin status, radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p = 0.02) compared to earlier. After stratification by radiation use, association of recurrence with treatment period persisted in those treated without radiation (HR 0.62, p = 0.003).

Conclusions

Recurrence rates for DCIS have fallen over time, with increases in screen detection, negative margins, and use of adjuvant therapies only partially explaining this decrease. The unexplained decline persists in women not receiving radiation, suggesting it is not due to changes in radiation efficacy but may be due to improvements in radiologic detection and pathologic assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.

    Article  PubMed  Google Scholar 

  2. Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):139–41.

    Article  PubMed  Google Scholar 

  3. Cuzick J, Sestak I, Pinder SE, et al. 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. 2011;12(1):21–9.

    Article  CAS  PubMed  Google Scholar 

  4. Donker M, Litiere S, Werutsky G, et al. 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. 2013;31(32):4054–9.

    Article  PubMed  Google Scholar 

  5. Wapnir IL, Dignam JJ, Fisher B, et al. 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. 2011;103(6):478–88.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Warnberg F, Garmo H, Emdin S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol. 2014;32(32):3613–8.

    Article  PubMed  Google Scholar 

  7. Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27(15):2466–73.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Cabioglu N, Hunt KK, Buchholz TA, et al. Improving local control with breast-conserving therapy: a 27-year single-institution experience. Cancer. 2005;104(1):20–9.

    Article  PubMed  Google Scholar 

  9. Canavan J, Truong PT, Smith SL, Lu L, Lesperance M, Olivotto IA. Local recurrence in women with stage I breast cancer: declining rates over time in a large, population-based cohort. Int J Radiat Oncol Biol Phys. 2014;88(1):80–6.

    Article  PubMed  Google Scholar 

  10. Mannino M, Yarnold JR. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother Oncol. 2009;90(1):14–22.

    Article  PubMed  Google Scholar 

  11. Ernst MF, Voogd AC, Coebergh JW, Poortmans PM, Roukema JA. Using loco-regional recurrence as an indicator of the quality of breast cancer treatment. Eur J Cancer. 2004;40(4):487–93.

    Article  CAS  PubMed  Google Scholar 

  12. Morrow M, Harris JR, Schnitt SJ. Surgical margins in lumpectomy for breast cancer–bigger is not better. N Engl J Med. 2012;367(1):79–82.

    Article  PubMed  Google Scholar 

  13. Zujewski JA, Harlan LC, Morrell DM, Stevens JL. Ductal carcinoma in situ: trends in treatment over time in the US. Breast Cancer Res Treat. 2011;127(1):251–7.

    Article  PubMed  Google Scholar 

  14. Collins LC, Achacoso N, Haque R, et al. Risk factors for non-invasive and invasive local recurrence in patients with ductal carcinoma in situ. Breast Cancer Res Treat. 2013;139(2):453–60.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Early Breast Cancer Trialists’ Collaborative Group, Correa C, McGale P, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;2010(41):162–77.

    Article  Google Scholar 

  16. Habel LA, Achacoso NS, Haque R, et al. Declining recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting. Breast Cancer Res. 2009;11(6):R85.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Solin LJ, Kurtz J, Fourquet A, et al. Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol. 1996;14(3):754–63.

    CAS  PubMed  Google Scholar 

  18. Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27(32):5319–24.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328(22):1581–6.

    Article  CAS  PubMed  Google Scholar 

  20. Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96(6):443–8.

    Article  PubMed  Google Scholar 

  21. Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999;353(9169):1993–2000.

    Article  CAS  PubMed  Google Scholar 

  22. Hiramatsu H, Bornstein BA, Recht A, et al. Local recurrence after conservative surgery and radiation therapy for ductal carcinoma in situ: possible importance of family history. Cancer J Sci Am. 1995;1(1):55–61.

    CAS  PubMed  Google Scholar 

  23. Halasz LM, Sreedhara M, Chen YH, et al. Improved outcomes of breast-conserving therapy for patients with ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2012;82(4):e581–6.

    Article  PubMed  Google Scholar 

  24. Feeley L, Kiernan D, Mooney T, et al. Digital mammography in a screening programme and its implications for pathology: a comparative study. J Clin Pathol. 2011;64(3):215–9.

    Article  PubMed  Google Scholar 

  25. Karssemeijer N, Bluekens AM, Beijerinck D, et al. Breast cancer screening results 5 years after introduction of digital mammography in a population-based screening program. Radiology. 2009;253(2):353–8.

    Article  PubMed  Google Scholar 

  26. Hambly NM, McNicholas MM, Phelan N, Hargaden GC, O’Doherty A, Flanagan FL. Comparison of digital mammography and screen-film mammography in breast cancer screening: a review in the Irish breast screening program. AJR Am J Roentgenol. 2009;193(4):1010–8.

    Article  PubMed  Google Scholar 

  27. Del Turco MR, Mantellini P, Ciatto S, et al. Full-field digital versus screen-film mammography: comparative accuracy in concurrent screening cohorts. AJR Am J Roentgenol. 2007;189(4):860–6.

    Article  PubMed  Google Scholar 

  28. Miller KL, Marks LB, Barrier RC Jr, et al. Increased sectioning of pathologic specimens with ductal carcinoma in situ of the breast: are there clinical consequences? Clin Breast Cancer. 2003;4(3):198–202.

    Article  PubMed  Google Scholar 

  29. Lester SC, Bose S, Chen YY, et al. Protocol for the examination of specimens from patients with ductal carcinoma in situ of the breast. Arch Pathol Lab Med. 2009;133(1):15–25.

    PubMed  Google Scholar 

  30. Siziopikou KP. Ductal carcinoma in situ of the breast: current concepts and future directions. Arch Pathol Lab Med. 2013;137(4):462–6.

    Article  CAS  PubMed  Google Scholar 

  31. McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709–15.

    Article  CAS  PubMed  Google Scholar 

  32. Wong JS, Chen YH, Gadd MA, et al. Eight-year update of a prospective study of wide excision alone for small low- or intermediate-grade ductal carcinoma in situ (DCIS). Breast Cancer Res Treat. 2014;143(2):343–50.

    Article  PubMed  Google Scholar 

  33. Rutter CE, Park HS, Killelea BK, Evans SB. Growing use of mastectomy for ductal carcinoma-in situ of the breast among young women in the United States. Ann Surg Oncol. 2015;22(7):2378–86.

    Article  PubMed  Google Scholar 

  34. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.

    Article  PubMed  Google Scholar 

  35. Memorial Sloan Kettering Cancer Center. Breast cancer nomogram: ductal carcinoma in situ recurrence. 2014. http://nomograms.mskcc.org/Breast/DuctalCarcinomaInSituRecurrencePage.aspx. Accessed 8 Apr 2015.

  36. Rudloff U, Jacks LM, Goldberg JI, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28(23):3762–9.

    Article  PubMed  Google Scholar 

  37. Sweldens C, Peeters S, van Limbergen E, et al. Local relapse after breast-conserving therapy for ductal carcinoma in situ: a European single-center experience and external validation of the Memorial Sloan-Kettering Cancer Center DCIS nomogram. Cancer J. 2014;20(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  38. Wang F, Li H, Tan PH, et al. Validation of a nomogram in the prediction of local recurrence risks after conserving surgery for Asian women with ductal carcinoma in situ of the breast. Clin Oncol. 2014;26(11):684–91.

    Article  CAS  Google Scholar 

  39. Collins LC, Achacoso N, Haque R, et al. Risk prediction for local breast cancer recurrence among women with DCIS treated in a community practice: a nested case-control study. Ann Surg Oncol. 2015. doi:10.1245/s10434-015-4641-x.

    Google Scholar 

Download references

Acknowledgment

This study was funded in part by National Institutes of Health, National Cancer Center Support Grant P30 CA008748.

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Preeti Subhedar MD, Cristina Olcese BS, Monica Morrow MD, FACS & Kimberly J. Van Zee MS, MD, FACS

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sujata Patil PhD

Authors
  1. Preeti Subhedar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Olcese BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sujata Patil PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica Morrow MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kimberly J. Van Zee MS, MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly J. Van Zee MS, MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Subhedar, P., Olcese, C., Patil, S. et al. Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years. Ann Surg Oncol 22, 3273–3281 (2015). https://doi.org/10.1245/s10434-015-4740-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4740-8

Keywords

Search

Navigation