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Risk factors for non-invasive and invasive local recurrence in patients with ductal carcinoma in situ

  • Epidemiology
  • Published:
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Abstract

We aimed to identify clinicopathologic factors associated with local recurrence (LR) in a large population of DCIS patients treated with breast-conserving therapy between 1990–2001 in three health plans. Regression methods were used to estimate relative risks (RR) of LR. Among 2,995 patients, 325 had a LR [10.9 %; median follow-up 4.8 years (range 0.5–15.7)]. After adjusting for health plan and treatment, risk of LR was increased among women <45 years (RR = 2.1, 95 % CI 1.5–2.8), African-Americans (RR = 1.6; 95 % CI 1.1–2.1) and those with DCIS detected because of signs/symptoms (RR = 1.6; 95 % CI 1.2–2.0). After also adjusting for age and diagnosis year, pathologic features associated with increased LR were larger lesion size (RR = 2.9 for ≥20 low power fields of DCIS; 95 % CI 1.6–5.6) and involved (RR = 2.9; 95 % CI 1.6–5.2), or close margins (RR = 2.4; 95 % CI 1.6–3.8). Presentation with symptoms/signs was associated with increased risk of invasive recurrence; while African-American race, larger tumor size, and involved/close tumor margins were more strongly associated with increased risk of DCIS recurrence. Our findings suggest some risk factors differ for non-invasive and invasive LRs and that most factors are only moderately associated with increased LR risk. Future research efforts should focus on non-clinicopathologic factors to identify more powerful risk factors for LR.

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Abbreviations

LR:

Local recurrence

RR:

Relative risk

CI:

Confidence interval

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Acknowledgments

We thank the women with DCIS who participated; also Luana Acton, Angela Capra, Michelle McGuire and Janis Yao of KP; Mayra Nicola of HPHC and Marilyn Skelly of PhenoPath Laboratories for project management and programming support. We are grateful to Dr. Monica Morrow for her insightful comments on an earlier draft. This study was supported by the Public Health Service grants U19 CA 79689 and R01 CA81302. This study was conducted under the auspices of the HMO Cancer Research Network (CRN).

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Authors and Affiliations

  1. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Laura C. Collins & Stuart J. Schnitt

  2. Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA

    Ninah Achacoso, Charles P. Quesenberry Jr. & Laurel A. Habel

  3. Research and Evaluation, Kaiser Permanente, Southern California, Pasadena, CA, USA

    Reina Haque

  4. Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA

    Larissa Nekhlyudov & Suzanne W. Fletcher

  5. Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA, USA

    Larissa Nekhlyudov

Authors
  1. Laura C. Collins
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  2. Ninah Achacoso
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  3. Reina Haque
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  4. Larissa Nekhlyudov
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  5. Suzanne W. Fletcher
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  6. Charles P. Quesenberry Jr.
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  7. Stuart J. Schnitt
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  8. Laurel A. Habel
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Correspondence to Laura C. Collins.

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Collins, L.C., 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 139, 453–460 (2013). https://doi.org/10.1007/s10549-013-2539-5

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  • DOI: https://doi.org/10.1007/s10549-013-2539-5

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