Characteristics Associated With Recurrence Among Women With Ductal Carcinoma In Situ Treated by Lumpectomy

Kerlikowske, Karla; Molinaro, Annette M.; Cha, Imok; Ljung, Britt–Marie; Ernster, Virginia L.; Stewart, Kim; Chew, Karen; Moore, Dan H.; Waldman, Fred

doi:10.1093/jnci/djg097

Cited by 222 publications

(183 citation statements)

References 48 publications

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“…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] . It has also been hypothesized that the efficacy of radiotherapy may be less in younger women 11 .…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…The proportion of women receiving conservative surgery increased from 7% in 1980 to 51% in 1996 (Lindqvist et al, 2002). Inadequately treated in situ breast carcinoma, for example, insufficient margin control, may have contributed to the observed risk increase (Yau et al, 2002;Fredriksson et al, 2003;Kerlikowske et al, 2003;Khan and Newman, 2004).…”

Section: Discussionmentioning

confidence: 99%

Risk of subsequent invasive breast carcinoma after in situ breast carcinoma in a population covered by national mammographic screening

2004

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Sweden was the first country to establish a nationwide breast cancer screening service. We used the Swedish Family-Cancer Database to evaluate the risk of invasive carcinoma after in situ carcinoma of the breast. Risk estimates for contralateral and ipsilateral invasive malignancies following age and histology specific in situ breast carcinomas were calculated using Poisson's regression analysis. The agreement between concordant and discordant morphologies of invasive and in situ breast cancer was measured using the kappa statistic. Women with in situ breast cancer showed a relative risk of 2.03 for contralateral and 3.94 for ipsilateral invasive breast cancer. The risk was higher for in situ carcinomas diagnosed before the age of 50 years and after lobular in situ breast cancers. A comparison of the risks during the past decades suggested that the risk of ipsilateral breast cancer has increased in Sweden but that of contralateral breast cancer has remained unchanged. In situ and the subsequent invasive breast cancers did not seem to share their morphologies.

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“…19,20 We estimated the increased risk of invasive cancer among patients with DCIS in the first 10 years after diagnosis using SEER data. 21,22 We abstracted local data on all-cause mortality. 23 …”

Section: Modelmentioning

confidence: 99%

Cost effectiveness of mammography screening for Chinese women

Wong

Kuntz

Cowling

et al. 2007

Cancer

102

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Low‐density polyethylene (LDPE) was treated with a low‐temperature cascade arc plasma torch (LTCAT) of argon with or without adding a reactive gas of oxygen or water vapor. The static sessile droplet method and the dynamic Wilhelmy balance method were employed to perform surface contact angle measurement in order to investigate and characterize the effects of LTCAT treatment on LDPE surfaces. These treatment effects included changes in surface wettability and surface stability and possible surface damage that would create low‐molecular‐weight oligomers on the treated surface. Experimental results indicated that the combination of static and dynamic surface contact angle measurements enabled a comprehensive investigation of these effects of plasma treatment on a polymer surface. Without the addition of a reactive gas, a 2‐s argon LTCAT treatment of LDPE resulted in a stable hydrophilic surface (with a water contact angle of 40°) and little surface damage. The addition of oxygen into argon LTCAT produced a less stable LDPE surface and showed more surface damage. Adding H2O vapor into argon LTCAT produced an extremely hydrophilic surface (with a water contact angle < 20°) of LDPE but with pronounced surface damage. When compared with conventional radio frequency (13.56 MHz) plasmas, LTCAT treatment provides a much more rapid, effective, and efficient method of surface modification of LDPE. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 99: 2528–2541, 2006

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Characteristics Associated With Recurrence Among Women With Ductal Carcinoma In Situ Treated by Lumpectomy

Cited by 222 publications

References 48 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

Risk of subsequent invasive breast carcinoma after in situ breast carcinoma in a population covered by national mammographic screening

Cost effectiveness of mammography screening for Chinese women

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