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

Alvarado, Rosalinda; Lari, Sara A.; Roses, Robert E.; Smith, Benjamin D.; Yang, Wei Tse; Mittendorf, Elizabeth A.; Arun, Banu K.; Lucci, Anthony; Babiera, Gildy; Wagner, Jamie L.; Caudle, Abigail S.; Meric‐Bernstam, Funda; Hwang, Rosa F.; Bedrosian, Isabelle; Hunt, Kelly K.; Kuerer, Henry Mark

doi:10.1245/s10434-012-2413-4

Cited by 70 publications

(45 citation statements)

References 32 publications

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“…We did not identify any differences in the pathologic features of dcis (such as high grade, presence of necrosis, or resection margin status) in younger women. A previous study noted that, compared with 20 . It is also possible that younger women are more likely to present with clinical symptoms (for example, a palpable lump) or more likely to have dense breasts or a family history of breast cancer, which have been shown to be associated with an increased risk of recurrence [21][22][23][24][25] .…”

Section: Discussionmentioning

confidence: 95%

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Kong¹,

Narod²,

Taylor³

et al. 2013

Curr. Oncol.

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also significantly associated with invasive lr (hr: 1.6; 95% ci: 1.0 to 2.4; p = 0.04). ConclusionsAge at diagnosis is a strong predictor of lr in women with dcis after treatment with bcs and radiotherapy. KEY WORDSDuctal carcinoma in situ, age, recurrence, young patients, radiation BACKGROUNDDuctal carcinoma in situ (dcis) is a noninvasive form of breast cancer that is most often diagnosed during mammographic screening. Although dcis is not life-threatening, up to 20% of women with dcis can develop invasive breast cancer at 10 years, which is associated with an increased risk of breast cancer mortality [1][2][3][4][5][6] . The goals of treating dcis are to maximize breast conservation, optimize cosmesis, and prevent the development of invasive breast cancer. Most women with dcis are treated with breastconserving surgery (bcs), followed by whole-breast irradiation. Radiotherapy after bcs has been proved to reduce the rate of local recurrence (both in situ and invasive) 7-12 . Randomized and nonrandomized clinical trials report that after bcs and radiation, approximately 12%-15% of women will experience a local recurrence within 10 years, and 5%-10% will develop an invasive local recurrence [7][8][9][10][11][12] .It is important to identify factors associated with the development of local recurrence and subsequent invasive breast cancer, because women with such factors may be candidates for more extensive therapy. It has been suggested that younger age at diagnosis is a risk factor for local recurrence after treatment for dcis 7,12-14 . Multivariable analyses from randomized clinical trials suggest that the efficacy of radiation ABSTRACT PurposeThe main goal of treating ductal carcinoma in situ (dcis) is to prevent the development of invasive breast cancer. Most women are treated with breastconserving surgery (bcs) and radiotherapy. Age at diagnosis may be a risk factor for recurrence, leading to concerns that additional treatment may be necessary for younger women. We report a populationbased study of women with dcis treated with bcs and radiotherapy and an evaluation of the effect of age on local recurrence (lr). MethodsAll women diagnosed with dcis in Ontario from 1994 to 2003 were identified. Treatments and outcomes were collected through administrative databases and validated by chart review. Women treated with bcs and radiotherapy were included. Survival analyses were performed to evaluate the effect of age on outcomes. ResultsWe identified 5752 cases of dcis; 1607 women received bcs and radiotherapy. The median follow-up was 10.0 years. The 10-year cumulative lr rate was 27% for women younger than 45 years, 14% for women 45-50 years, and 11% for women more than 50 years of age (p < 0.0001). The 10-year cumulative invasive lr rate was 22% for women younger than 45 years, 10% for women 45-50 years, and 7% for women more than 50 years of age (p < 0.0001). On multivariate analyses, young age (<45 years) was significantly associated with lr and invasive lr [hazard ratio (hr) for lr: 2.6; 95% confidence interval...

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Section: Discussionmentioning

confidence: 95%

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Kong¹,

Narod²,

Taylor³

et al. 2013

Curr. Oncol.

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“…(25) In a recent report of Alvarado et al on 2,037 patients with a diagnosis of pure DCIS treated between 1996 and 2009, tumor size was a significant prognosticator, with 5-year LR rates of 5.6% vs 2.2% for lesions over and under 15 mm respectively. (26) …”

Section: Tumor Sizementioning

confidence: 99%

Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

Stoleru¹,

Stoleru²

2017

chr

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RezumatCarcinomul ductal in situ al sânului este un precursor non-invaziv al cancerului mamar şi este reprezentat de un grup de leziuni cu potenţial malign variabil. Tratamentul local optim pentru pacientele cu carcinom ductal in situ rãmane un subiect controversat, în ciuda rezultatelor provenite din mai multe trialuri randomizate. Radioterapia care urmeazã intervenţiei chirurgicale conservatoare reduce aproximativ la jumãtate riscul de recidivã localã, dar nu are impact în ceea ce priveşte supravieţuirea pe termen lung. Studiile clinice desfãşurate pânã în prezent nu au putut identifica un subgrup de paciente cu carcinom ductal in situ cu risc scãzut, la care sã se poata renunţa în siguranţã la radioterapie, dupã intervenţia chirurgicala conservatoare. În lucrare sunt prezentate rezultate ale studiilor clinice în care s-a utilizat chirurgia conservatoare a sânului urmatã sau nu de radioterapie. Alte subiecte abordate se referã la stabilirea indicaţiei terapeutice în cazul carcinomului ductal in situ cu risc scãzut şi la noi tendinţe în radioterapia pentru carcinomul ductal in situ. Review Articlebreast cancerand represents a heterogenous group of lesions with different malignant potential. Despite several randomized trials, there is still controversy regarding the optimal local treatment for DCIS patients. The addition of radiotherapy after breast conserving surgery approximately halves the local recurrence risk but has no impact on long-term survival. Clinical studies failed to identify a low risk subgroup of DCIS patients treated with breast conserving surgery in whom radiotherapy can be safely omitted. Results of clinical trials of breast conserving surgery ± radiotherapy are summarized. Treatment decision making in low risk DCIS and current tendencies in the radiotherapy for DCIS are other issues addressed in this paper.

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“…In a DCIS neoplasm, the proliferation of malignant cells is limited only to the epithelium without invasion into the periductal stromal tissue [1,2]. In recent studies, DCIS was diagnosed in 15% to 30% of all breast carcinomas.…”

Section: Introductionmentioning

confidence: 99%

“…In recent studies, DCIS was diagnosed in 15% to 30% of all breast carcinomas. In between 25% and 56% of clinically occult breast cancers, DCIS was detected mammographically [1,2]. DCIS is regarded as a potential precursor of invasive carcinoma and a risk factor for the development of cancer in the same or contralateral breast [3,4].…”

Section: Introductionmentioning

confidence: 99%

Influence of the imaging method and histopathological features on preoperative size prediction of ductal carcinoma in situ (DCIS) of the breast

Niedźwiecki¹,

Piekarski²,

Jeziorski³

2013

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SummaryAim of the study: The aim of the study was to evaluate the accuracy of mammography and ultrasonography in predicting preoperative DCIS size compared to final histopathologic measurement of the extent of DCIS.Material and methods: A retrospective analysis was performed of the clinical, histopathological and imaging records of 32 consecutive female patients initially treated by breast-conserving surgery for DCIS between 1999 and 2005. Group 1 consisted of 19 female patients with a palpable breast tumor, while group 2 comprised 13 female individuals with no palpable breast lesion. All patients were preoperatively diagnosed with biopsy.Results: In group 1, mammography size was smaller than histopathological size in 14 patients (73.68%), while they were equal in 5 cases (26.31%). However, in group 2, mammography size was the same as histopathological size in 5 cases (38.46%), but was smaller in 8 individuals (61.53%).The degree of the underestimations for both imaging methods compared to pathological size were identical, with a value of 1.1 ±0.9 cm and 1.2 ±1.1 cm for groups 1 and 2, respectively.Furthermore, in both study groups, as final histopathologic size decreased, the degree of underestimation increased (p < 0.05).Conclusions: The present study demonstrates that smaller DCIS pathological size is associated with greater discrepancies in imaging method size prediction.

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

Cited by 70 publications

References 32 publications

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis

Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

Influence of the imaging method and histopathological features on preoperative size prediction of ductal carcinoma in situ (DCIS) of the breast

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