Outcomes of Screening-Detected Ductal Carcinoma In Situ Treated with Wide Excision Alone

Fong, Jonathan; Kurniawan, Emil D; Rose, Allison; Mou, Arlene; Collins, John P.; Miller, Julie Ann; Mann, G. Bruce

doi:10.1245/s10434-011-1748-6

Cited by 18 publications

(11 citation statements)

References 33 publications

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“…DCIS cases (n = 48) were ascertained from a population-based mammographic screening cohort with clinical follow-up available 15 (Table 1, Supplementary Table S1). All cases were treated by surgical wide excision only and were selected to enrich for high-grade cases (77% of cases compared with 58% in the full cohort 15 ).…”

Section: Resultsmentioning

confidence: 99%

“…All cases were treated by surgical wide excision only and were selected to enrich for high-grade cases (77% of cases compared with 58% in the full cohort 15 ). DNA was extracted and copy number was obtained by using SNP arrays ( Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Cases were recruited as described previously through NorthWestern BreastScreen Victoria, a population-based mammographic screening service, between 1994 and 2005. 15 All women were treated with wide local excision but without radiotherapy. Non-recurrent cases were defined as those with no incidence of ipsilateral or contralateral DCIS or invasive breast cancer within 7 years of the primary DCIS diagnosis (n = 46).…”

Section: Tumour Samples Dna Extraction and Copy Number Analysismentioning

confidence: 99%

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Copy number analysis of ductal carcinoma in situ with and without recurrence

et al. 2015

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Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer and a frequent mammographic finding requiring treatment. Up to 25% of DCIS can recur and half of recurrences are invasive, but there are no reliable biomarkers for recurrence. We hypothesised that copy number aberrations could predict likelihood of recurrence. We analysed a cohort of pure DCIS cases treated only with wide local excision for genome-wide copy number and loss of heterozygosity using Affymetrix OncoScan MIP arrays. Cases included those without recurrence within 7 years (n = 25) and with recurrence between 1 and 5 years after diagnosis (n = 15). Pure DCIS were broadly similar in copy number changes compared with invasive breast cancer, with the consistent exception of a greater frequency of ERBB2 amplification in DCIS. There were no significant differences in age or ER status between the cases with a recurrence vs those without. Overall, the DCIS cases with recurrence had more copy number events than the DCIS without recurrence. The increased copy number appeared non-random with several genomic regions showing an increase in frequency in recurrent cases, including 20q gain, ERBB2 amplification and 15q loss. Copy number changes may provide prognostic information for DCIS recurrence, but validation in additional cohorts is required. Modern Pathology (2015Pathology ( ) 28, 1174Pathology ( -1184 doi:10.1038/modpathol.2015 published online 19 June 2015 Ductal carcinoma in situ (DCIS) is a proliferation of malignant cells within breast ducts without invasion through the basement membrane. A number of lines of evidence demonstrate that DCIS is a non-obligate precursor of invasive breast cancer, including the natural history of untreated DCIS, 1 the high risk of ipsilateral invasive breast cancer after a diagnosis of DCIS and the common clonal genetic events found in DCIS and synchronous or recurrent invasive breast cancer. 2 Prior to population-based screening mammography, DCIS was an unusual finding comprising only 3-5% of all breast neoplasms. Currently,~20% of cases of screen-detected breast neoplasia are DCIS. 3 Standard treatment has become wide local excision of DCIS with or without adjuvant radiotherapy. 4 Recent clinical trials have found that~25% of DCIS treated with local excision only will recur within 15 years, with the greatest risk of recurrence in the first 5 years. 5 Approximately half of the recurrences will be invasive carcinoma, requiring more extensive treatment, and with a possible decrease in disease-specific survival. 6 Radiotherapy reduces the recurrence rate by about 50%, so despite the fact that only small a small proportion of patients will benefit, many clinicians recommend radiotherapy because of the implications of invasive recurrence. The most commonly used predictive models to estimate the recurrence risk with or without radiotherapy include DCIS grade, tumour size, width

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Tumour Samples Dna Extraction and Copy Number Analysismentioning

confidence: 99%

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Copy number analysis of ductal carcinoma in situ with and without recurrence

et al. 2015

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“…Finally, we have entered an era of increasing awareness among women and diagnosis of smaller tumors is more often reported. Outcome of screening-detected DCIS treated with excision alone may be more favourable, and although recurrence rates of 15% at 5 years are reported, these are often successfully salvaged with breast conservation, with overall breast-specific survival of 99% [25]. …”

Section: Discussionmentioning

confidence: 99%

Ductal Carcinoma In Situ: What Can We Learn from Clinical Trials?

Fortunato

Poccia

Paula

et al. 2012

International Journal of Surgical Oncology

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Ductal Carcinoma in situ has been diagnosed more frequently in the last few years and now accounts for approximately one-fourth of all treated breast cancers. Traditionally, this disease has been treated with total mastectomy, but conservative surgery has become increasingly used in the absence of unfavourable clinical conditions, if a negative excision margin can be achieved. It is controversial whether subgroups of patients with favourable in situ tumors could be managed by conservative surgery alone, without radiation. As the disease is diagnosed more frequently in younger patients, these issues are very relevant, and much research has focused on this topic in the last two decades. We reviewed randomized trials regarding adjuvant radiation after breast-conservative surgery and compared data with available retrospective studies.

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“…Overall, however, women with DCIS have a very favorable prognosis and a diagnosis of DCIS is not likely to affect a woman's survival. Furthermore, there has been concern about the overtreatment of DCIS, particularly small lesions that might not have ever become clinically evident 17. Thus, addressing the problem of suboptimal communication and the potential for poor‐quality decision‐making and psychosocial outcomes is of great clinical importance.…”

Section: Introductionmentioning

confidence: 99%

Challenges in ductal carcinoma in situ risk communication and decision‐making

Partridge

Elmore

Saslow

et al. 2012

CA A Cancer J Clinicians

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In September 2010, the American Cancer Society and National Cancer Institute convened a conference to review current issues in DCIS risk communication and decision-making and to identify directions for future research. Specific topics included patient and healthcare provider knowledge and attitudes about DCIS and its treatment, how to explain DCIS to patients given the heterogeneity of the disease, consideration of nomenclature changes, and the utility of decision tools/aids. This report describes the proceedings of the workshop in the context of the current literature and discusses future directions. Evidence suggests that there is lack of clarity about the implications and risks of a diagnosis of DCIS, among patients, providers and researchers. Research is needed to understand better the biology and mechanisms of the progression of DCIS to invasive breast cancer and the factors which predict those subtypes of DCIS which do not progress, as well as efforts to improve communication and informed decision-making surrounding DCIS.

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Outcomes of Screening-Detected Ductal Carcinoma In Situ Treated with Wide Excision Alone

Cited by 18 publications

References 33 publications

Copy number analysis of ductal carcinoma in situ with and without recurrence

Copy number analysis of ductal carcinoma in situ with and without recurrence

Ductal Carcinoma In Situ: What Can We Learn from Clinical Trials?

Challenges in ductal carcinoma in situ risk communication and decision‐making

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