Outcomes for Women with Minimal-Volume Ductal Carcinoma In Situ Completely Excised at Core Biopsy
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Overdiagnosis and overtreatment of ductal carcinoma in situ (DCIS) are concerns, especially for women with low-volume, screen-detected DCIS. This study aimed to evaluate the outcomes for such patients.
Women who had minimal-volume DCIS (mDCIS, defined as DCIS diagnosed by core biopsy but with no residual disease on the surgical excision) treated with breast-conserving surgery from 1990 to 2011 were identified. Ipsilateral and contralateral breast events (IBE and CBE) were compared by competing-risk (CR) analysis. Kaplan–Meier (KM) estimates and log-rank tests were used to evaluate covariates.
The study identified 290 cases of mDCIS. The median age of the patients was 53 years. Radiation therapy (RT) was performed for 27.6% and endocrine therapy for 16.2% of the patients. The median follow-up period was 6.8 years. Overall, the IBE rates were 4.3% at 5 years and 12.3% at 10 years. Among the women not receiving RT, the 5- and 10-year IBE rates (5.4 and 14.5%) were higher than the CBE rates (1.8 and 2.7%). Among those receiving RT, the IBE rates (1.5 and 6.0%) were lower than the CBE rates (4.1 and 15.6%). The women receiving RT trended toward significantly lower IBE rates (p = 0.07). Age, grade, and endocrine therapy were not significantly associated with IBE risk.
Among the patients with mDCIS who did not receive RT, the IBE risk was substantially higher than the CBE risk, demonstrating that even DCIS of very low volume is associated with clinically relevant disease. The finding that the IBE risk was greater than the CBE risk supports current strategies that treat DCIS as a precursor rather than a risk marker. Women with mDCIS are not at negligible risk for IBE in the absence of adjuvant therapy.
The preparation of this manuscript was supported by NIH/NCI Cancer Center Support Grant no. P30 CA008748.
There are no conflicts of interest.
- 5.Elshof LE, Tryfonidis K, Slaets L, van Leeuwen-Stok AE, Skinner VP, Dif N, et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ: The LORD study. Eur J Cancer. 2015;51:1497–510.CrossRefPubMedGoogle Scholar
- 7.The Alliance for Clinical Trials In Oncology Foundation (principal investigator: Hwang S). Comparison of Operative Versus Medical Endocrine Therapy for Low-Risk DCIS: The COMET Trial. 2016. Retrieved 10 February 2017. http://www.pcori.org/research-results/2016/comparison-operative-versus-medical-endocrine-therapy-low-risk-dcis-comet.
- 9.Early Breast Cancer Trialists’ Collaborative G, Correa C, McGale P, Taylor C, Wang Y, Clarke M, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;2010:162–77.Google Scholar
- 12.Donker M, Litiere S, Werutsky G, Julien JP, Fentiman IS, Agresti R, 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;31:4054–9.CrossRefPubMedGoogle Scholar
- 20.Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, et al. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387:857–65.CrossRefPubMedGoogle Scholar
- 29.Sweldens C, Peeters S, van Limbergen E, Janssen H, Laenen A, Patil S, 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;20:1–7.CrossRefPubMedGoogle Scholar
- 32.Sedloev T, Vasileva M, Kundurzhiev T, Hadjieva T. Validation of the Memorial Sloan-Kettering Cancer Center nomogram in the prediction of local recurrence risks after conserving surgery for Bulgarian women with DCIS of the breast. Conference Paper, presented at the 2nd World Congress on Controversies in Breast Cancer (CoBrCa), Barcelona, Spain, September 2016. Retrieved 22 March 2017 at https://www.researchgate.net/publication/312232507_Validation_of_the_Memorial_Sloan-Kettering_Cancer_Center_nomogram_in_the_prediction_of_local_recurrence_risks_after_conserving_surgery_for_Bulgarian_women_with_DCIS_of_the_breast.
- 33.Yi M, Meric-Bernstam F, Kuerer HM, Mittendorf EA, Bedrosian I, Lucci A, et al. Evaluation of a breast cancer nomogram for predicting risk of ipsilateral breast tumor recurrences in patients with ductal carcinoma in situ after local excision. J Clin Oncol. 2012;30:600–7.CrossRefPubMedPubMedCentralGoogle Scholar