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Can we select individuals with low risk ductal carcinoma in situ (DCIS)? A population-based outcomes analysis

  • Epidemiology
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Abstract

Ductal carcinoma in situ (DCIS), a non-invasive breast cancer, is usually treated by breast-conserving surgery (BCS). Randomized trials prove that the addition of radiotherapy (XRT) leads to lower rates of recurrence. Despite the evidence, half of women do not receive XRT after BCS. It is unknown how well clinicians identify women with low risk DCIS for treatment by BCS alone or to what extent women with DCIS develop recurrent cancer due to the omission of radiotherapy. We report the outcomes of a population of women with DCIS treated with BCS, alone or with radiotherapy, and evaluate the effectiveness of each therapeutic approach. All women diagnosed with DCIS and treated with BCS, alone or with radiotherapy in Ontario from 1994 to 2003 were identified. Treatments and outcomes were validated by chart review. Survival analyses were used to study the development of local recurrence (LR) in relation to patient and tumor characteristics and the use of radiotherapy. The cohort included 3,762 women treated with breast-conserving therapy; 1,895 of whom (50 %) also received radiation. At 10 years median follow-up, LR developed in 233 (12 %) women who received radiotherapy and in 363 (19 %) of women who did not (p < 0.0001). The 10-year actuarial LR rate for women who did and did not receive radiotherapy was 12.7 and 20.0 % (p < 0.0001). Differences were significant for both for invasive LR (7.0 vs. 10.0 %, p < 0.0001) and for DCIS recurrence (6.1 vs. 10.8 %, p < 0.0001). We estimate that 22 % of recurrences diagnosed in Ontario women treated for DCIS between 1994 and 2003 would have been prevented if all patients had received radiotherapy. The omission of radiotherapy after BCS for DCIS resulted in substantive recurrences that might have been avoided with treatment. Additional markers are needed to identify a low risk group in whom radiation can be safely omitted.

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Acknowledgments

The authors would like to acknowledge the contribution of Ms. Barb Zurowski for administrative support and Mr. Bruce Haan for administrative support with computer programming. The authors would also like to acknowledge the contribution of Dr. Lili Fu, Dr. Cyrille Bicamumpaka, Dr. Reza Behjati, and Dr. Kazuya Onuma for their assistance in the pathology review. Dr. Eileen Rakovitch holds the LC Campbell Chair in Breast Cancer Research. This study was supported by a Grant from the Canadian Cancer Society Research Initiative.

Conflict of interest

No conflict of interest to report.

Ethics

Ethics approval for this study was obtained by Sunnybrook Ethics Board, Sunnybrook Health Science Centre.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Eileen Rakovitch, Iwa Kong & Lawrence Paszat

  2. Women’s College Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Steven A. Narod

  3. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Eileen Rakovitch, Deva Thiruchelvam, Refik Saskin, Carole Taylor & Lawrence Paszat

  4. Department of Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Sharon Nofech-Mozes & Wedad Hanna

  5. University of Toronto, 27 King’s College Circle, Toronto, ON, M5S 1A1, Canada

    Eileen Rakovitch, Sharon Nofech-Mozes, Steven A. Narod, Wedad Hanna, Susan J. Done, Naomi Miller, Bruce Youngson, Iwa Kong & Lawrence Paszat

  6. Department of Pathology, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada

    Sandip Sengupta

  7. Department of Pathology, Henderson General Hospital, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada

    Leela Elavathil

  8. Department of Pathology, Thunder Bay Regional Health Sciences Centre, 980 Oliver Road, Thunder Bay, ON, P7B 6V4, Canada

    Prashant A. Jani

  9. Department of Pathology, Campbell Family Institute for Breast Cancer Research, University Health Network, R. Fraser Elliott Building 1st Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    Susan J. Done, Naomi Miller & Bruce Youngson

  10. Department of Pathology, London Health Sciences Centre, 800 Commissioners Road East, P.O. Box 5010, London, ON, N6A 5W9, Canada

    Alan Tuck

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  1. Eileen Rakovitch
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  2. Sharon Nofech-Mozes
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  3. Steven A. Narod
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  4. Wedad Hanna
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  8. Alan Tuck
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  12. Susan J. Done
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  13. Naomi Miller
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  14. Bruce Youngson
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  15. Iwa Kong
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  16. Lawrence Paszat
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Correspondence to Eileen Rakovitch.

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Rakovitch, E., Nofech-Mozes, S., Narod, S.A. et al. Can we select individuals with low risk ductal carcinoma in situ (DCIS)? A population-based outcomes analysis. Breast Cancer Res Treat 138, 581–590 (2013). https://doi.org/10.1007/s10549-013-2455-8

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  • DOI: https://doi.org/10.1007/s10549-013-2455-8

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