Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years

Abstract

Background Randomized trials of radiation after breast-conserving surgery (BCS) for DCIS found substantial rates of recurrence, with half of recurrences invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed, and are largely attributed to systemic therapy improvements. Here we examine recurrence rates after BCS for DCIS over 3 decades at one institution. Methods We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978–2010. Cox proportional hazard models were used to investigate the association between treatment period and recurrence, controlling for other variables. Results 363 (12%) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0–30 years); 732 were followed for ≥10 years. The 5-year recurrence rate for 1978–1998 was 13.6% versus 6.6% for 1999–2010 (hazard ratio [HR] 0.62, p<0.0001). Controlling for age, family history, presentation, nuclear grade, necrosis, number of excisions, margin status, radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p=0.02) compared to earlier. After stratification by radiation use, association of recurrence with treatment period persisted in those treated without radiation (HR 0.62, p=0.003). Conclusions Recurrence rates for DCIS have fallen over time. Increases in screen-detection, negative margins, and use of adjuvant therapies only partially explain the decrease. The unexplained decline persists in women not receiving radiation, suggesting it is not due to changes in radiation efficacy, but may be due to improvements in radiologic detection and pathologic assessment.

Impact of Age on Risk of Recurrence of Ductal Carcinoma In Situ: Outcomes of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years

“…Other factors analyzed were: family history of breast cancer (defined as ≥1 first- or second-degree family member), presentation (radiological or clinical), nuclear grade (low/intermediate or high), necrosis, number of excisions required (≤2 or ≥3), margin status (positive/close (≤2mm) or negative (>2mm)), use of adjuvant RT and endocrine therapy, and treatment time period (≤1998 or ≥1999). 15 …”

Breast Cancer Arising from a Suspected Fibroadenoma during Pregnancy: A Case Report and Review of Literature

“…Although comparative studies in determining the natural history of fibroadenomas seem to be equivocal, Kuijper et al in a clonality study showed that given the right condition fibroadenomas could progress in both epithelial (carcinoma) and stromal direction (phyllodes tumor) [22]. Higher incidence of CIS (Carcinoma in situ) found in transforming fibroadenoma highlights the importance of appropriate evaluation of such condition because, by early diagnosis and proper management, breast CIS is highly manageable with an excellent prognosis [23]. Breast cancer is the most common malignancy occurring during pregnancy.…”

Verzicht auf die adjuvante Radiotherapie beim duktalen Carcinoma in situ

“…Beachtenswerterweise haben die 10-Jahres-Lokalrezidivraten im zeitlichen Verlauf abgenommen, laut einer Publikation vom Memorial Sloan Kettering-Cancer Center in New York von etwa 20 % im Zeitraum 1978-1998 auf etwa 14 % im Zeitraum 1999-2010 [4]. Allerdings beschränkte sich diese Reduktion nur auf die allein operierten Patientinnen und betraf nicht diejenigen, die eine adjuvante RT erhalten hatten und unverändert weiterhin ein signifikant geringeres Lokalrezidivrisiko haben.…”