Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review, meta-analysis and meta-regression analysis

Stuart, Kirsty; Houssami, Nehmat; Taylor, Richard; Hayen, Andrew; Boyages, John

doi:10.1186/s12885-015-1904-7

Cited by 82 publications

(61 citation statements)

References 67 publications

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“…This is similar to the situation for local recurrences following DCIS [7][8][9][10][11], and suggests that an in-breast invasive event following a case of DCIS may be better characterized as an invasive local recurrence than as a new primary cancer. However, it is not clear if the distinction between invasive recurrences and invasive primary cancers is clinically relevant.…”

Section: Introductionmentioning

confidence: 49%

Impact of a prior diagnosis of DCIS on survival from invasive breast cancer

Sopik

Iqbal

Sun³

et al. 2016

Breast Cancer Res Treat

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A diagnosis of invasive breast cancer after DCIS can be described as a new primary cancer or as a local invasive recurrence. It is of interest to determine if, among women with early-stage breast cancer, a past history of DCIS influences survival. We retrieved the records of 306,249 women diagnosed with stage I or stage II breast cancer between 2004 and 2012, in the surveillance, epidemiology, and end results registries database, of whom 5395 had a previous diagnosis of DCIS. For each patient, we extracted information on the year of diagnosis, age at diagnosis, tumor size, nodal status, grade, estrogen receptor status, type of surgery (lumpectomy/mastectomy), use of radiotherapy (no/yes), prior DCIS (no/yes), cause of death, and follow-up time. For each case with prior DCIS, we recorded information on the year of diagnosis of DCIS, laterality of DCIS, and treatments received for DCIS. We matched 3979 patients with a prior DCIS to 3979 patients without a prior DCIS, according to the various prognostic features of the invasive cancer. We estimated the risk of death from breast cancer for patients with invasive ductal carcinoma, with and without a prior diagnosis of DCIS. We identified 306,249 women with stage I/II breast cancer, of whom 2335 had a prior ipsilateral DCIS and 3060 had a prior contralateral DCIS. Breast cancer-specific survival at 9 years was 94.6 % for patients with a prior DCIS (ipsilateral or contralateral) and was 95.2 % for patients with no prior DCIS (p = 0.32). In a matched analysis (3979 matched pairs), the hazard ratio for death from breast cancer for patients with a prior ipsilateral DCIS, compared to patients with no prior DCIS, was 0.91 (95 % CI = 0.49-1.68; p = 0.75). A prior diagnosis of ipsilateral DCIS does not impact upon the prognosis of women with early-stage invasive breast cancer. This suggests that primary breast cancers and local invasive recurrences following DCIS are similar conditions and should be treated in the same way.

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Section: Introductionmentioning

confidence: 49%

Impact of a prior diagnosis of DCIS on survival from invasive breast cancer

Sopik

Iqbal

Sun³

et al. 2016

Breast Cancer Res Treat

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“…Although survival is excellent with each treatment option, the rates of local recurrence vary widely between the different treatments (7, 11, 21). …”

Section: Standard Treatment Options For Dcismentioning

confidence: 99%

“…Following mastectomy, the theoretical risk of local recurrence of a purely in situ lesion should be essentially zero. However, a low rate of local recurrence has been documented, with a study level meta-analysis of 8 retrospective studies demonstrating an adjusted 10-year local recurrence rate of 2.6% (95% CI 0.8–4.5%) (21). As a pre-invasive lesion, mastectomy may be overtreatment for many women with small, localized DCIS.…”

Section: Standard Treatment Options For Dcismentioning

confidence: 99%

Controversies in the Treatment of Ductal Carcinoma in Situ

Barrio

Zee

2017

Annu. Rev. Med.

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Ductal carcinoma in situ (DCIS) accounts for 20% of all newly diagnosed breast cancers. Mastectomy was once the gold standard for the treatment of DCIS; however, breast-conserving surgery (BCS) has been adopted as the treatment of choice for patients with small, screen-detected lesions. Both adjuvant radiation and hormonal therapy following BCS have been demonstrated in randomized trials to reduce the risk of invasive recurrence, but neither affects survival. With the variety of surgical and adjuvant treatment options available, there has been great interest in tailoring the treatment to the individual, with the goal of optimizing the balance of risks and benefits according to the values and priorities of the woman herself. Prospective studies of women with “low-risk” DCIS have successfully identified women at lower than average risk, but have not achieved the goal of identifying a subset of women with DCIS at minimal risk of recurrence after surgical excision alone.

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“…Accordingly, a follow-up study for up to 20 years after a biopsy diagnosis of DCIS without subsequent treatment reported that 28% of these patients recurred for IDC within approximately 15 years [7]. This study and other similar reports [3, 8] suggest that some DCIS lesions remain dormant and have a very slow progression rate to IDC. It is also possible that some DCIS lesions do not become invasive.…”

Section: Introductionmentioning

confidence: 68%

Progression Potential of Ductal Carcinoma in situ Assessed by Genomic Copy Number Profiling

et al. 2018

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Background: Ductal carcinoma in situ (DCIS) of the breast is heterogeneous in terms of the risk of progression to invasive ductal carcinoma (IDC). To treat DCIS appropriately for its progression risk, we classified individual DCIS by its profile of genomic changes into 2 groups and correlated them with clinicopathological progression factors. Methods: We used surgically resected, formalin-fixed, paraffin-embedded tissues of 22 DCIS and 30 IDC lesions. We performed immunohistochemical intrinsic subtyping, array-based comparative genomic hybridization, and unsupervised clustering. Results: The samples were divided into 2 major clusters, A and B. Cluster A showed a greater number of gene and chromosome copy number alterations, a larger IDC/DCIS ratio, a higher frequency of nonluminal subtype, a lower frequency of luminal subtype, and a higher nuclear grade, when compared with cluster B. However, there was no difference in the frequencies of lymph node metastasis between clusters A and B. We identified 9 breast-cancer-related genes, including TP53 and GATA3, that highly contributed to the discrimination of A and B clusters. Conclusion: Classification of breast tumors into rapidly progressive cluster A and the other (cluster B) may contribute to select the treatment appropriate for their progression risk.

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Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review, meta-analysis and meta-regression analysis

Cited by 82 publications

References 67 publications

Impact of a prior diagnosis of DCIS on survival from invasive breast cancer

Impact of a prior diagnosis of DCIS on survival from invasive breast cancer

Controversies in the Treatment of Ductal Carcinoma in Situ

Progression Potential of Ductal Carcinoma in situ Assessed by Genomic Copy Number Profiling

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