Long term follow-up of women with ductal carcinoma in situ treated with breast-conserving surgery

Zee, Kimberly J. Van; Liberman, Laura; Şamli, Billur; Tran, Nhi; McCormick, Beryl; Petrek, Jeanne A.; Rosen, Paul Peter; Borgen, Patrick I.

doi:10.1002/(sici)1097-0142(19991101)86:9<1757::aid-cncr18>3.0.co;2-v

Cited by 115 publications

(71 citation statements)

References 53 publications

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“…Contrary to some previously published reports, 18,23 young age does not predict for the presence of residual tumor on reexcision in our data. The reasons for this are unclear.…”

Section: Discussioncontrasting

confidence: 99%

“…On multivariate analysis, however, only margin status remained significant. 18 Others have largely confirmed these risk factors. [11][12][13][14]19,20 Of potential prognostic factors, margin width has garnered the most attention, both because of the proposal that this is the dominant factor in predicting for local recurrence with WLE alone 5 and because of the finding that this is the only potential risk factor that can be influenced by physician intervention.…”

Section: Discussionmentioning

confidence: 96%

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The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast

Neuschatz

DiPetrillo

Steinhoff

et al. 2002

Cancer

105

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The introduction and development of comprehensive two‐dimensional gas chromatography offers greatly enhanced resolution and identification of organic analytes in complex mixtures compared to any one‐dimensional separation technique. Initially promoted by the need to resolve highly complex petroleum samples, the technique’s enormous separation power and enhanced ability to gather information has rapidly attracted the attention of analysts from all scientific fields. In this Minireview, we highlight the fundamental theory, recent advances, and future trends in the instrumentation and application of comprehensive two‐dimensional column separation.

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“…Contrary to some previously published reports, 18,23 young age does not predict for the presence of residual tumor on reexcision in our data. The reasons for this are unclear.…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 96%

The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast

Neuschatz

DiPetrillo

Steinhoff

et al. 2002

Cancer

105

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“…Although the results of the current study and the results of some other studies 18,22 have not demonstrated this relation, our study population was small. Furthermore, our analysis showed that HER-2/neu expression, which was correlated with age, also was found to be significantly associated with high-grade tumor.…”

Section: Discussioncontrasting

confidence: 88%

“…24 -26 However, other studies, including the results from the large EORTC 10853 trial, have not found younger age to be associated with more adverse pathologic factors such as high grade. 18,22 It has been suggested that invasive and intraductal breast tumors arising in young patients have different underlying biologic characteristics that may contribute to the worse prognosis observed in this group. Overexpression or absence of various molecular markers has been reported to correlate with outcome in invasive breast carcinoma.…”

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confidence: 99%

Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women

Rodrigues

Dillon

Carter

et al. 2003

Cancer

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BACKGROUNDPatients diagnosed with ductal carcinoma in situ (DCIS) at a young age appear to have a different natural history and biology, including a higher local relapse rate, than patients diagnosed later in life. The current study compared various pathologic and molecular features of DCIS arising in a cohort of young women with those of DCIS arising in a cohort of older women to identify potential biologic differences between these two populations of patients.METHODSThe study population consisted of 20 patients age < 42 years and 34 patients age > 60 years who were treated at Yale University School of Medicine with breast‐conserving therapy (BCT) and whose archival paraffin blocks were available and had sufficient tumor for staining. The original slides from each case were reviewed and the most representative specimen block from each case was processed for immunohistochemical staining. Pathologic characteristics evaluated for each case included histology, grade, and presence of necrosis. Paraffin‐embedded sections were immunohistochemically evaluated for expression of HER‐2/neu, estrogen receptor (ER), progesterone receptor (PR), bcl‐2, cyclin D1, Ki‐67, and p53.RESULTSAlthough there was no difference in pathologic features of the tumors between the two groups, HER‐2/neu was found to be overexpressed in a greater percentage of the younger population (P = 0.06). There was no apparent difference in expression of the other markers. Of note, HER‐2/neu expression was correlated with high nuclear grade (P = 0.004), necrosis (P = 0.06), and ER and PR negativity (P = 0.01 and P = 0.03, respectively) in the combined population.CONCLUSIONSThe current study data suggested that HER‐2/neu overexpression in younger patients may characterize a biologic difference in their tumor and may partially contribute to their higher risk of recurrence. Further studies are needed to assess whether this difference holds independent of grade and to evaluate the prognostic significance of HER‐2/neu overexpression in DCIS. Cancer 2003;97:1393–1403. © 2003 American Cancer Society.DOI 10.1002/cncr.11204

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“…Age and margin status are the most important factors related to the risk of local recurrence. The impact of young age on the outcome of treatment of DCIS has been studied by several groups (2,(6)(7)(8)(9). In the EORTC 10853 trial, women aged 40 years or younger had a 34% risk of local recurrence at 10 years compared with 19% of the women older than 40 years ( Figure 1).…”

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confidence: 99%

Local and Systemic Outcomes in DCIS Based on Tumor and Patient Characteristics: The Radiation Oncologist's Perspective

Bijker

Tienhoven

2010

JNCI Monographs

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Four randomized controlled trials have shown the benefit of radiotherapy after breast-conserving surgery for ductal carcinoma in situ (DCIS) (1-4). Radiotherapy reduces the risk of both DCIS and invasive local recurrence with about 50%, with a similar relative reduction of the recurrence risk in all clinical and pathological subgroups analyzed (5). Age and margin status are the most important factors related to the risk of local recurrence. The impact of young age on the outcome of treatment of DCIS has been studied by several groups (2,6-9). In the EORTC 10853 trial, women aged 40 years or younger had a 34% risk of local recurrence at 10 years compared with 19% of the women older than 40 years ( Figure 1). Potential factors responsible for the increased risk of local recurrence after breast-conserving therapy (BCT) for DCIS in young women are adverse prognostic pathological features that appear to occur more frequently in young women and treatment-related factors such as a smaller excision volume (10). However, to date, data are limited and sometimes inconsistent (10). In the EORTC trial, young women had a higher rate of clinically detected lesions than older women (63% vs 24%) (11). Younger women had a similar rate of excisions without free margins (11). At present, young age per se should not be a contraindication for BCT, especially because it is unknown whether these patients have a superior long-term prognosis if treated by mastectomy. Local recurrences followingboth skin sparing and simple-mastectomy after DCIS are reported and also seem to occur particularly in younger women (12,13).Numerous studies have shown an increased risk of local recurrence when DCIS was excised with doubtful or involved margins (2,6,7,14,15). Various thresholds have been reported as a safe margin status, from "the inked margin not being involved with DCIS," to ≥1, 2, 3, or 5 mm, or even ≥1 cm. Single institutional studies have suggested that radiotherapy can safely be omitted when margins are ≥1 cm (16); however, prospective studies have not confirmed this (17). In the EORTC trial, when margins were not reported free, the local recurrence rate at 10 years was overall 32% (Figure 2), with 39% in the local excision group and 24% in the excision plus radiotherapy group. To conclude, when margins are involved, the risk of recurrence is high, even after radiotherapy. Yet, it remains unknown which is an optimal minimal margin for BCT.Involved margins after lumpectomy for DCIS are an indication for further surgery. If, after excision and/or re-excision, no clear margins can be obtained, a mastectomy will be indicated. Particularly in larger lesions, the chance of performing a microscopically complete local excision is considered low. In practice, 25%-30% of women with DCIS are treated with mastectomy (18). The extent of the DCIS and inability to obtain clear margins with breast-conserving surgery are likely to be responsible for this percentage.In all randomized trials, the dose delivered was 50 Gy without an additional dose to the tumo...

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Long term follow-up of women with ductal carcinoma in situ treated with breast-conserving surgery

Cited by 115 publications

References 53 publications

The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast

The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast

Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women

Local and Systemic Outcomes in DCIS Based on Tumor and Patient Characteristics: The Radiation Oncologist's Perspective

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