Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race

Madubata, Chinwe C.; Liu, Ying; Goodman, Melody S.; Yun, Shumei; Yu, Jennifer; Lian, Min; Colditz, Graham A.

doi:10.1007/s10549-016-4030-6

Cited by 16 publications

(21 citation statements)

References 30 publications

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“…Madubata et al examined the relationship between time to RT initiation and race among 9138 women diagnosed with DCIS between 1996 and 2011 in the Missouri Cancer Registry. Although there was no difference in rates of RT use noted by race, black women experienced significant delays in the initiation of RT after BCS (8.1 weeks vs 6.3 weeks in white women; odds ratio, 1.9 [ P <.0001]) . In addition to a delay in RT, black women also experienced an increased risk of IBTR, although a causal relationship could not be determined …”

Section: Discussionmentioning

confidence: 92%

“…Although there was no difference in rates of RT use noted by race, black women experienced significant delays in the initiation of RT after BCS (8.1 weeks vs 6.3 weeks in white women; odds ratio, 1.9 [P<.0001]). 24 In addition to a delay in RT, black women also experienced an increased risk of IBTR, although a causal relationship could not be determined. 24 Race also may affect the risk of disease-specific mortality in women with DCIS.…”

Section: Risk Of Ibtr With Rt Delay In Dcis/shurell Et Almentioning

confidence: 96%

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Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ

Shurell

Olcese

Patil

et al. 2017

Cancer

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BACKGROUND:The current study was conducted to examine the association between ipsilateral breast tumor recurrence (IBTR) and the timing of radiotherapy (RT) in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS). METH-ODS: Women with DCIS who were treated with BCS and RT from 1980 through 2010 were identified from a prospectively maintained database. IBTR rates, measured from the time of RT completion, were compared between those who initiated RT 8 weeks, >8 to 12 weeks, and >12 weeks after the completion of surgery. The association between RT timing and IBTR was evaluated by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis. RESULTS: A total of 1323 women met the inclusion criteria. The median follow-up was 6.6 years, with 311 patients followed for 10 years. A total of 126 IBTR events occurred. Patients were categorized by RT timing: 806 patients (61%) with timing of 8 weeks, 386 patients (29%) with timing of >8 to 12 weeks, and 131 patients (10%) with timing >12 weeks. The 5-year and 10-year IBTR rates were 5.8% and 13.0%, respectively, for RT starting 8 weeks after surgery; 3.8% and 7.6%, respectively, for RT starting >8 to 12 weeks after surgery; and 8.8% and 23.0%, respectively, for an RT delay >12 weeks after surgery (P 5 .004). On multivariable analysis, menopause (hazard ratio [HR], 0.54; P 5 .0009) and endocrine therapy (HR, 0.45; P 5 .002) were found to be protective against IBTR, whereas a delay in RT >12 weeks compared with 8 weeks was associated with a higher risk of IBTR (HR, 1.92; P 5 .014). There was no difference in IBTR noted between RT initiation at 8 weeks and initiation at >8 to 12 weeks after BCS (P 5 .3). CONCLUSIONS: A delay in RT >12 weeks is associated with a significantly higher risk of IBTR in women undergoing BCS for DCIS. Efforts should be made to avoid delays in starting RT to minimize the risk of disease recurrence. Cancer 2018;124:46-54. V C 2017 American Cancer Society.KEYWORDS: breast cancer, ductal carcinoma in situ, radiotherapy, recurrence. INTRODUCTIONDuctal carcinoma in situ (DCIS), or stage 0 breast cancer, is a noninvasive breast lesion that comprises approximately 20% of all breast cancer diagnoses. In 2017, it is estimated that nearly 53,000 women will be diagnosed with DCIS in the United States. 1,2 The majority of these women (60%-77%) will undergo breast-conserving surgery (BCS), with or without adjuvant therapy. [3][4][5][6] Survival is excellent after BCS for DCIS, with 10-year breast cancer-specific mortality rates of 1% to 4%. 7-10 However, rates of ipsilateral breast tumor recurrence (IBTR) are not insignificant, with the risk of IBTR reported to be 1% to 3% per year, 5,8 with long-term recurrence rates reported to range from 25% to 35% after BCS alone in 4 large, prospective, randomized controlled trials. 9,[11][12][13] A marked decrease in the risk of IBTR in patients with DCIS has been observed with the use of adjuvant radiotherapy (RT) after BCS. The Early Breast Cancer Trialists' Collabor...

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Section: Discussionmentioning

confidence: 92%

Section: Risk Of Ibtr With Rt Delay In Dcis/shurell Et Almentioning

confidence: 96%

Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ

Shurell

Olcese

Patil

et al. 2017

Cancer

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“…6,9,35,36 Among those who initiated endocrine therapy, blacks were more likely than whites to be nonadherent to therapy, and Asians were more likely to continue therapy. Some variables influencing DCIS outcomes (eg, surgical margins and endocrine therapy) were unavailable.…”

Section: Discussionmentioning

confidence: 99%

“…3 We and others have demonstrated a significant variation by race and ethnicity in the risk of developing breast cancer after DCIS. [5][6][7][8][9][10][11] An increased risk of ipsilateral breast tumors has been observed in Hispanic women with DCIS, 5,12 and an increased risk of contralateral breast tumors has been identified in Asian women with DCIS. [5][6][7][8][9][10][11] An increased risk of ipsilateral breast tumors has been observed in Hispanic women with DCIS, 5,12 and an increased risk of contralateral breast tumors has been identified in Asian women with DCIS.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11] An increased risk of ipsilateral breast tumors has been observed in Hispanic women with DCIS, 5,12 and an increased risk of contralateral breast tumors has been identified in Asian women with DCIS. 5,6 However, black women with IBC who have no prior history of DCIS are far more likely than white counterparts to present with biologically aggressive features, including a lack of ER, progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression and high RNA expression-based recurrence scores. 5,6 However, black women with IBC who have no prior history of DCIS are far more likely than white counterparts to present with biologically aggressive features, including a lack of ER, progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression and high RNA expression-based recurrence scores.…”

Section: Introductionmentioning

confidence: 99%

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Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ

Liu

West

Weber

et al. 2019

Cancer

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Background General populations of black women have a higher risk of developing breast cancer negative for both estrogen receptor (ER) and progesterone receptor (PR) in comparison with white counterparts. Racial differences remain unknown in the risk of developing aggressive invasive breast cancer (IBC) that is characterized by negativity for both ER and PR (ER–PR–) or higher 21‐gene recurrence scores after ductal carcinoma in situ (DCIS). Methods This study identified 163,892 women (10.5% black, 9.8% Asian, and 8.6% Hispanic) with incident DCIS between 1990 and 2015 from the Surveillance, Epidemiology, and End Results data sets. Cox proportional hazards regression was used to estimate hazards ratios (HRs) of subsequent IBC classified by the hormone receptor status and 21‐gene recurrence scores. Results During a median follow‐up of 90 months, 8333 women developed IBC. In comparison with white women, the adjusted HR of subsequent ER–PR– breast cancer was 1.86 (95% confidence interval [CI], 1.57‐2.20) for black women (absolute 10‐year difference, 2.2%) and 1.40 (95% CI, 1.14‐1.71) for Asian women (absolute 10‐year difference, 0.4%); this was stronger than the associations for ER+ and/or PR+ subtypes (Pheterogeneity = .0004). The 21‐gene recurrence scores of subsequent early‐stage, ER+ IBCs varied by race/ethnicity (Pheterogeneity = .057); black women were more likely than white women to have a recurrence score of 26 or higher (HR, 1.38; 95% CI, 1.00‐1.92). No significant difference was observed in the risks of subsequent IBC subtypes for Hispanic women. Conclusions Black and Asian women with DCIS had higher risks of developing biologically aggressive IBC than white counterparts. This should be considered in treatment decisions for black and Asian patients with DCIS.

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Factors influencing the initiation of adjuvant endocrine therapy in patients with estrogen receptor-positive ductal carcinoma in situ: a single institution experience

Levy

Farag

Cole

2022

Breast Cancer Res Treat

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Purpose This study evaluates whether race, socioeconomic status, insurance type, oncological provider type, and prior cancer treatment are associated with the suggestion and acceptance of hormonal therapy in patients with estrogen receptor (ER)-positive Ductal carcinoma in situ (DCIS). This study also assesses whether disparities exist pertaining to prescription of such medications. Methods This single-center retrospective study included 111 patients diagnosed with DCIS between 2020 and 2021. Data collected included race, type of insurance, prescribing providers, and socioeconomic status. We used zip codes to identify the poverty levels in these areas as published in the United States Census Bureau and stratified the patients into quartiles accordingly. Chi-Square statistics were used to calculate significance levels. Results There was no significant correlation between the intake of hormonal therapy and race (p = 0.60), insurance (p = 0.50), socioeconomic (p = 0.58), or providers (p = 0.99). 79.3% of women were offered endocrine therapy. Of those who were offered endocrine therapy, 70.8% accepted. Of patients not on hormonal therapy, 45.8% were not recommended the medications by their provider, and 54.2% declined treatment when offered. Conclusion In this study, patients’ demographics and providers were not associated with adjuvant hormonal therapy initiation in DCIS. Our results show that abstaining from endocrine therapy in DCIS patients is both due to lack of provider recommendation and patient rejection of these medications. The wide variation in hormonal therapy treatment among ER-positive DCIS patients suggests a need for improved provider-patient communication regarding the risks and benefits of endocrine therapy in order to ensure a shared decision-making process.

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Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race

Cited by 16 publications

References 30 publications

Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ

Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ

Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ

Factors influencing the initiation of adjuvant endocrine therapy in patients with estrogen receptor-positive ductal carcinoma in situ: a single institution experience

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