The effect of age in the outcome and treatment of older women with ductal carcinoma in situ

Ho, Alice Y.; Goenka, Anuj; Ishill, Nicole; Zee, Kimberly J. Van; McLane, A.; Gonzales, Anne Marie; Tan, Lee K.; Cody, Hiram S.; Powell, Simon N.; McCormick, Beryl

doi:10.1016/j.breast.2010.07.005

Cited by 13 publications

(16 citation statements)

References 33 publications

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“…34,35 We found no difference in microcalcification morphology or distribution between these two groups. However, younger patients were more likely to have dense breast tissue and multicentric/multifocal disease and undergo mastectomy, while older patients were more likely to present with ER-negative disease.…”

Section: Discussionmentioning

confidence: 48%

Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence

et al. 2015

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Purpose To determine the relationship of microcalcification morphology and distribution with clinical, histopathologic, biologic features and local recurrence (LR) in patients with pure ductal carcinoma in situ (DCIS) of the breast. Methods All patients with pure DCIS who underwent preoperative mammography at our institution from 1996 through 2009 were identified. Mammographic findings were classified according to the ACR BI-RADS lexicon. Associations between mammographic findings and clinical, histopathologic, biologic characteristics and LR were analyzed. Statistical inference used multiple logistic regression and Cox proportional hazards regression adjusted for age and confounding due to bias from nonrandomized selection of radiation therapy. Results We identified 1657 patients with microcalcifications visualized on mammography. The mean age at diagnosis was 55 years (SD, 11). The mean follow-up was 7 years (range, 1–16). Ipsilateral LR was 4% in segmentectomy (987) and 1.5% in mastectomy (670) patients. Increased LR risk was seen in patients with dense breast tissue (p<0.05) and larger DCIS size (p<0.01). Radiation therapy was associated with a 2.8-fold decrease in the LR risk. Fine linear (branching) microcalcifications were associated with 5.2-fold increase in LR. Extremely dense breast tissue was associated with positive/close margins (p=0.04) and multicentricity (p<0.01). Younger women were more likely to have extremely dense breast tissue (p<0.0001), multicentric disease (p<0.0004), and undergo mastectomy (p<0.0001). Conclusions Dense breast tissue, large DCIS size, and fine linear (branching) microcalcifications were associated with increased LR, yet overall LR rates remained low. Extremely dense breast tissue was a risk factor for multicentricity and positive margins in DCIS.

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Section: Discussionmentioning

confidence: 48%

Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence

et al. 2015

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“…2,5,20,24–27 Smith et al 28 found that it contributed to a significant reduction in LRR in women over 65 years old. A more recent study by Ho et al 29 showed no difference in LRR in women over 60 whether or not radiotherapy was used, suggesting that it may be safely eliminated in some older women. This coincides with our findings that young women benefit to a higher degree than older women from radiotherapy after BCS.…”

Section: Discussionmentioning

confidence: 97%

Biology, Treatment, and Outcome in Very Young and Older Women with DCIS

et al. 2012

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Background This study examines a modern cohort of women with ductal carcinoma-in-situ (DCIS) in order to identify potential differences in clinical presentation, treatments, and outcome based on age. Methods From 1996 to 2009, a total of 2037 patients with pure DCIS were treated. Clinical presentation, pathologic factors, type of surgery and adjuvant therapy, and local recurrence rates among age groups were compared and analyzed. Median follow-up was 5.2 years. Results There were 132 patients (6.5 %) aged <40, 1,690 (83 %) aged 40–70, and 215 (10.5 %) aged >70. Younger patients (<40) were significantly more likely to have a family history of breast cancer, present with clinical symptoms, undergo mastectomy with immediate reconstruction, and have a contralateral prophylactic mastectomy (P < 0.05). Older patients (>70) were significantly less likely to use adjuvant radiotherapy and tamoxifen (P <0.05). No significant differences were found in DCIS size, estrogen receptor status, necrosis, or contralateral breast cancer based on age. Among women <40, 29.3 % had evidence of multicentric disease versus 17.7 and 13.3 % in the women aged 40–70 and those >70, respectively (P = 0.004). On multivariate analysis, younger age (<40), larger-size DCIS (≥1.5 cm), and no use of radiotherapy were significant independent predictors of locoregional recurrence. The 5 year rates of local recurrence were 10.1 % in women <40 compared with 3.2 % in older women (P = 0.005). Conclusions Younger patients with DCIS more often have multicentric disease, present with clinical findings, and opt for or require mastectomy with immediate reconstruction. Conservative surgery is only appropriate for younger patients if adjuvant radiotherapy is delivered.

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“…In 2017, it is estimated that nearly 53,000 women will be diagnosed with DCIS in the United States . The majority of these women (60%‐77%) will undergo breast‐conserving surgery (BCS), with or without adjuvant therapy . Survival is excellent after BCS for DCIS, with 10‐year breast cancer‐specific mortality rates of 1% to 4% .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 The majority of these women (60%-77%) will undergo breast-conserving surgery (BCS), with or without adjuvant therapy. [3][4][5][6] Survival is excellent after BCS for DCIS, with 10-year breast cancer-specific mortality rates of 1% to 4%. [7][8][9][10] However, rates of ipsilateral breast tumor recurrence (IBTR) are not insignificant, with the risk of IBTR reported to be 1% to 3% per year, 5,8 with long-term recurrence rates reported to range from 25% to 35% after BCS alone in 4 large, prospective, randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ

Shurell

Olcese

Patil

et al. 2017

Cancer

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BACKGROUND:The current study was conducted to examine the association between ipsilateral breast tumor recurrence (IBTR) and the timing of radiotherapy (RT) in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS). METH-ODS: Women with DCIS who were treated with BCS and RT from 1980 through 2010 were identified from a prospectively maintained database. IBTR rates, measured from the time of RT completion, were compared between those who initiated RT 8 weeks, >8 to 12 weeks, and >12 weeks after the completion of surgery. The association between RT timing and IBTR was evaluated by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis. RESULTS: A total of 1323 women met the inclusion criteria. The median follow-up was 6.6 years, with 311 patients followed for 10 years. A total of 126 IBTR events occurred. Patients were categorized by RT timing: 806 patients (61%) with timing of 8 weeks, 386 patients (29%) with timing of >8 to 12 weeks, and 131 patients (10%) with timing >12 weeks. The 5-year and 10-year IBTR rates were 5.8% and 13.0%, respectively, for RT starting 8 weeks after surgery; 3.8% and 7.6%, respectively, for RT starting >8 to 12 weeks after surgery; and 8.8% and 23.0%, respectively, for an RT delay >12 weeks after surgery (P 5 .004). On multivariable analysis, menopause (hazard ratio [HR], 0.54; P 5 .0009) and endocrine therapy (HR, 0.45; P 5 .002) were found to be protective against IBTR, whereas a delay in RT >12 weeks compared with 8 weeks was associated with a higher risk of IBTR (HR, 1.92; P 5 .014). There was no difference in IBTR noted between RT initiation at 8 weeks and initiation at >8 to 12 weeks after BCS (P 5 .3). CONCLUSIONS: A delay in RT >12 weeks is associated with a significantly higher risk of IBTR in women undergoing BCS for DCIS. Efforts should be made to avoid delays in starting RT to minimize the risk of disease recurrence. Cancer 2018;124:46-54. V C 2017 American Cancer Society.KEYWORDS: breast cancer, ductal carcinoma in situ, radiotherapy, recurrence. INTRODUCTIONDuctal carcinoma in situ (DCIS), or stage 0 breast cancer, is a noninvasive breast lesion that comprises approximately 20% of all breast cancer diagnoses. In 2017, it is estimated that nearly 53,000 women will be diagnosed with DCIS in the United States. 1,2 The majority of these women (60%-77%) will undergo breast-conserving surgery (BCS), with or without adjuvant therapy. [3][4][5][6] Survival is excellent after BCS for DCIS, with 10-year breast cancer-specific mortality rates of 1% to 4%. 7-10 However, rates of ipsilateral breast tumor recurrence (IBTR) are not insignificant, with the risk of IBTR reported to be 1% to 3% per year, 5,8 with long-term recurrence rates reported to range from 25% to 35% after BCS alone in 4 large, prospective, randomized controlled trials. 9,[11][12][13] A marked decrease in the risk of IBTR in patients with DCIS has been observed with the use of adjuvant radiotherapy (RT) after BCS. The Early Breast Cancer Trialists' Collabor...

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The effect of age in the outcome and treatment of older women with ductal carcinoma in situ

Cited by 13 publications

References 33 publications

Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence

Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence

Biology, Treatment, and Outcome in Very Young and Older Women with DCIS

Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ

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