Risk of death from breast cancer after treatment for ductal carcinoma <i>in situ</i>

Wadsten, Charlotta; Garmo, Hans; Fredriksson, Irma; Sund, Malin; Wärnberg, Fredrik

doi:10.1002/bjs.10589

Cited by 19 publications

(21 citation statements)

References 27 publications

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“…In addition, treatment choices are highly linked to patient and tumor characteristics [39] and so, it is impossible to know from the data the extent to which the low risk of death among women diagnosed with DCIS is a consequence of the treatment choice or reflects the relatively benign nature of the disease-or both. Small tumor size has been associated with reduced mortality risk [40]; however, we did not find any significant effect. Seemingly, risk of death across ER expression profile tumors did not differ from that expected in the general population.…”

Section: Mortalitycontrasting

confidence: 94%

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

et al. 2018

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Purpose We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994 and to estimate the all-cause mortality excess risk of diagnosed women. Methods Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). Results Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). Conclusions Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

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Section: Mortalitycontrasting

confidence: 94%

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

et al. 2018

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“…A large case–control study from Sweden also came to similar conclusions [ 24 ]. In that study, 96 women diagnosed with primary DCIS between 1992 and 2012 who later died of breast cancer were identified and compared with a group of 318 controls (women diagnosed with primary DCIS who were alive at the time of death of the corresponding case).…”

Section: Part 2: the Seer Study: Mortality After Dcismentioning

confidence: 52%

Is invasion a necessary step for metastases in breast cancer?

Narod

Sopik

2018

Breast Cancer Res Treat

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PurposeTo review the empirical evidence to support the conventional (sequential) model of breast cancer progression, which is based on the paradigm that cancer passes through several stages, including an in situ stage prior to an invasive stage, and thereafter (in some cases) disseminates to the lymph nodes and distant organs.MethodsWe review the cancer literature of the last 50 years which relates to the prevention of invasive breast cancer (through radiotherapy or surgery) and reductions in the mortality for breast cancer.ResultsFor both invasive cancers and DCIS, the literature indicates that prevention of in-breast invasive recurrences does not prevent death from breast cancer. Moreover, the presence of residual cancer cells in the breast after breast-conserving surgery does not compromise the cure rate.ConclusionWe propose an alternate (parallel) model of breast cancer wherein there is a small pool of cancer stem cells which have metastatic potential from their inception and which disseminate synchronously through several routes—to the breast stroma, to the lymph nodes and to distant organs. Cancer cells which disseminate to the breast give rise to cells which make up the bulk of the tumour mass but these are not the source of the distant metastases.

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“…Many population-based studies examining the various treatments in patients with DCIS have confirmed a reduction in local recurrences with local therapies (mastectomy vs lumpectomy and lumpectomy plus radiotherapy vs lumpectomy alone) 4,5,6,15 ; however, most have reported no significant difference in breast cancer mortality. 4,5,6,7,8,15,16 …”

Section: Discussionmentioning

confidence: 99%

Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy

2018

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Key Points Question Is adjuvant radiation associated with a reduction in breast cancer mortality in patients treated for ductal carcinoma in situ? Findings Using a matched approach in a large cohort of patients treated for ductal carcinoma in situ, treatment with lumpectomy and radiotherapy was associated with a significantly reduced risk of breast cancer–specific mortality compared with treatment with lumpectomy alone (hazard ratio, 0.77; 95% CI, 0.67-0.88) or mastectomy alone (hazard ratio, 0.75; 95% CI, 0.65-0.87). Meaning Adjuvant radiation is associated with a small but significant breast cancer survival benefit in patients with ductal carcinoma in situ that cannot be accounted for by enhancing local control.

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Risk of death from breast cancer after treatment for ductal carcinoma in situ

Cited by 19 publications

References 27 publications

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994–2013)

Is invasion a necessary step for metastases in breast cancer?

Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy

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