Declining recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting

Habel, Laurel A.; Achacoso, Ninah; Haque, Reina; Nekhlyudov, Larissa; Fletcher, Suzanne W.; Schnitt, Stuart J.; Collins, Laura C.; Geiger, Ann M.; Puligandla, Balaram; Acton, Luana; Quesenberry, Charles P.

doi:10.1186/bcr2453

Cited by 24 publications

(34 citation statements)

References 35 publications

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“…The overall mission of the CRN is “to increase the effectiveness of preventive, curative, and supportive interventions for major cancers through a program of collaborative research, and to determine the effectiveness of cancer control interventions that span the natural history of major cancers among diverse populations and health systems.”[25] Because CRN data are derived from integrated health delivery systems, the capture of events and procedures for covered patients is generally robust.…”

Section: Methodsmentioning

confidence: 99%

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Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community

Hassett

Jiang

Habel

et al. 2016

Breast Cancer Res Treat

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Purpose We examined the clinical/pathologic features of ipsilateral second breast cancers (IP-SBCs) following breast-conserving surgery (BCS) for DCIS among community-treated patients, and ascertained the degree of correlation between the features of index DCIS and IP-SBC events. Methods From a Cancer Research Network cohort of DCIS patients diagnosed 1990–2001 and treated with BCS, we identified women who subsequently developed an ipsilateral DCIS or invasive breast cancer. All index DCIS tumors underwent expert pathology review. Pathologic characteristics of IP-SBCs were abstracted from available medical records. Logistic regression was used to examine associations between pathologic characteristics and identify factors associated with invasive versus non-invasive IP-SBC. Results Of 1969 DCIS patients, 182 developed an IP-SBC within a median of 38 months (range 6–160). IP-SBCs were slightly more commonly non-invasive (53%) vs. invasive (47%). Of invasive IP-SBCs, 31% were high grade, 67% were <20 mm, 74% were estrogen-receptor (ER) positive, 7% were HER2 positive, and 16% were node-positive. Of non-invasive IP-SBCs, 33% were high grade. Comparing index DCIS and IP-SBC specimens, there was moderate-high correlation for HR status and grade. Among patients with IP-SBCs, those who were younger and whose index DCIS tumors were HR negative had shorter intervals (within 3 years) between index and IP-SBC diagnoses. No index DCIS feature was statistically significantly associated with an IP-SBC that was invasive versus non-invasive. Conclusions Understanding the characteristics of SBCs and identifying correlations between these and index DCIS events could influence treatment choices for DCIS, and may help patients and providers develop treatment paradigms for SBCs.

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Section: Methodsmentioning

confidence: 99%

“…[25] The study design and data collection methods for the CRN DCIS cohort study have been described in detail elsewhere and are briefly summarized below. [26] Two of the three sites that participated in the DCIS cohort study collected additional data on SBC events (KPNC and HPHC). Our analysis only included patients from these two sites.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community

Hassett

Jiang

Habel

et al. 2016

Breast Cancer Res Treat

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“…Numerous risk factors for recurrence have been identified, including age, 4–6, 15, 16 family history, 17–19 clinical presentation, 4, 5, 20 number of excisions, 16 nuclear grade and necrosis, 21–25 year of surgery, 16, 26 and margin status. 4–6, 16, 20, 24, 27–29 Three prospective studies have successfully combined multiple factors to prospectively identify women at relatively low risk for recurrence after excision alone.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Margin Width and Recurrence of Ductal Carcinoma In Situ

Zee

Subhedar²,

Olcese³

et al. 2015

Annals of Surgery

102

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Structured abstract Objective Our goal was to investigate, in a large population of women with DCIS and long follow-up, the relationship between margin width and recurrence, controlling for other characteristics. Summary Background Data While DCIS has minimal mortality, recurrence rates after breast-conserving surgery (BCS) are significant, and half are invasive. Positive margins are associated with increased risk of local recurrence, but there is no consensus regarding optimal negative margin width. Methods We retrospectively reviewed a prospective database of DCIS patients undergoing BCS from 1978–2010. Univariate and Cox proportional hazard models were used to investigate the association between margin width and recurrence. Results 2996 cases were identified, of which 363 recurred. Median follow-up for women without recurrence was 75mo (range 0–30years); 732 were followed for ≥10yrs. Controlling for age, family history, presentation, nuclear grade, number of excisions, radiotherapy (RT), endocrine therapy, and year of surgery, margin width was significantly associated with recurrence in the entire population. Larger negative margins were associated with a lower hazard ratio compared to positive margins. An interaction between RT and margin width was significant (p<0.03); the association of recurrence with margin width was significant in those without RT (p<0.0001), but not in those with RT (p=0.95). Conclusions In women not receiving RT, wider margins are significantly associated with a lower rate of LR. Obtaining wider negative margins may be important in reducing the risk of recurrence in women who choose not to undergo RT, and may not be necessary in those that receive RT.

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“…This phenomenon is supported by a study of DCIS cases in three health maintenance organizations within the Cancer Research Network [29]. Among cases treated with BCS, overall 5-year DFS improved from 81.5 % for cases diagnosed in 1990-1991 to 89 % in 1998-1999.…”

Section: Discussionmentioning

confidence: 81%

Tumor Microenvironment and Progression to Invasion after a Diagnosis of Ductal Carcinoma In Situ

Trentham‐Dietz¹,

Keely²

2013

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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. REPORT DATE November 2013 REPORT TYPE PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER University of WisconsinMadison, WI 53715-1218 SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 SPONSOR/MONITOR'S REPORT NUMBER(S) DISTRIBUTION / AVAILABILITY STATEMENTApproved for Public Release; Distribution Unlimited SUPPLEMENTARY NOTES ABSTRACTDuctal carcinoma in situ (DCIS) makes up 18% of all new breast cancer diagnoses, and is considered a precursor to invasive breast cancer even though the majority of cases-almost 70%-may never progress to invasive disease. Markers that identify which patients are most likely to experience progression are critically needed so that fewer patients are over-treated. This study is evaluating two novel tumor markers that may indicate greater risk of tumor progression based on recent work that suggests that stromal syndecan-1 expression induces an extracellular matrix with aligned collagen fiber architecture, and that this collagen alignment in turn facilitates malignant cell invasion. We are using archived tumor tissue from 267 cases of DCIS of the breast to evaluate syndecan-1 expression and collagen alignment. These DCIS cases, diagnosed between 1995 and 1999, have been followed for breast cancer outcomes; 13% of cases have experienced a second breast cancer diagnosis. Analysis suggests that treatment and method of detection are important covariates to include in statistical modeling. Preliminary analysis of collagen alignment and syndecan-1 expression suggests that features of the tumor microenvironment are related with disease-free survival after a diagnosis of DCIS. Progress report: Evaluation of the collagen alignment patterns for the tumor tissue slides has been completed. Collagen fibers were imaged using second harmonic generation (SHG) microscopy, which is a non-linear optical imaging form of microscopy. The technique takes advantage of the unique non-centrosymmetric structure of collagen in combination with the multiphoton a...

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Declining recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting

Cited by 24 publications

References 35 publications

Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community

Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community

Relationship Between Margin Width and Recurrence of Ductal Carcinoma In Situ

Tumor Microenvironment and Progression to Invasion after a Diagnosis of Ductal Carcinoma In Situ

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