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

Cancer ◽  
2017 ◽  
Vol 124 (1) ◽  
pp. 46-54 ◽  
Author(s):  
Elizabeth Shurell ◽  
Cristina Olcese ◽  
Sujata Patil ◽  
Beryl McCormick ◽  
Kimberly J. Van Zee ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Disease Recurrence ◽  
Increased Risk ◽  
Risk Of Disease

Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ (DCIS): Comparison of patients with and without index surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 519-519
Author(s):  
Marc D Ryser ◽  
Laura Hendrix ◽  
Samantha M. Thomas ◽  
Thomas Lynch ◽  
Anne McCarthy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Absolute Risk ◽  
Breast Conserving Surgery ◽  
Absolute Difference ◽  
Locoregional Treatment ◽  
Increased Risk

519 Background: Most women diagnosed with ductal carcinoma in situ (DCIS) undergo surgical resection, potentially leading to overtreatment of patients who would not develop clinically significant breast cancer in the absence of locoregional treatment. We compared the risk of ipsilateral invasive breast cancer (iIBC) between DCIS patients who received breast conserving surgery (BCS) for their index diagnosis of DCIS (BCS group) and patients who did not receive any locoregional treatment within 6 months of diagnosis (surveillance [SV] group). Methods: A treatment-stratified random sample of patients diagnosed with screen-detected and biopsy-confirmed DCIS in 2008-14 was selected from 1,330 Commission on Cancer-accredited facilities (20/site). Excluding patients who received a mastectomy ≤6 months, the final analytic cohort contained 14,245 (88.2%) BCS and 1,914 (11.8%) SV patients. Subsequent breast events were abstracted up to 10 years after diagnosis. Primary outcome was the 8-year absolute difference in iIBC risk between BCS and SV; a subgroup analysis was performed for grade I/II patients. A propensity score (PS) model for treatment was fitted with sampling design (SD) weighting and random effects for patients within facilities. Absolute risk differences were estimated using PS-SD-weighted Kaplan Meier estimators. Results: Overall, median age at diagnosis was 61 years (IQR: 52-69) and median follow-up was 5.8 years (95% CI 5.7-6.1). The majority of patients were Caucasian (81.9%), with estrogen receptor-positive (80.6%), and nuclear grade I/II (54.5%) DCIS. The fraction of patients with a Charlson comorbidity score of ≥2 was higher in SV (14.2%) compared to BCS (6.4%, p < 0.001). The 8-year risk of iIBC was 3.0% (95% CI: 2.4%-3.6%) for BCS and 7.7% (95% CI: 4.9%-10.5%) for SV, with an absolute risk difference of 4.7% (95% CI: 4.5%-4.9%; log-rank p < 0.001). Among patients with grade I/II tumors, the 8-year risk of iIBC was 3.1% (95% CI: 2.3%-4.0%) for BCS and 6.1% (95% CI: 2.5%-9.8%) for SV; difference: 3.0% (95% CI: 2.7%-3.2%; p = 0.005). Conclusions: Despite an increased risk of iIBC in SV patients compared to BCS patients, the 8-year risk did not exceed 10% in either group. The risk of recurrence in BCS patients was comparable to previously reported estimates. These data demonstrate a considerable degree of overtreatment among patients with non-high grade DCIS. Prospective clinical trials will help determine the tradeoffs between universally directed as opposed to selectively applied surgery for low risk DCIS.

SP8.1.8 Factors influencing the post-operative upgrade of ductal carcinoma in situ (DCIS) to invasive cancer

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Aminah Khan ◽  
Tiffany Tzortzidis ◽  
Natasha Tzortzidis ◽  
Douglas Brown ◽  
Jane Macaskill ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Percutaneous Biopsy ◽  
Invasive Cancer ◽  
High Grade ◽  
Palpable Lump ◽  
Initial Surgery ◽  
Increased Risk

Abstract Aims Ductal carcinoma in situ (DCIS) can be upgraded on pathological histology to invasive cancer and require a subsequent sentinel node biopsy (SNB). This second procedure increases the morbidity and costs of treating DCIS. Our study aims to establish the proportion of preoperatively diagnosed DCIS that is upgraded and identify factors associated with this upgrading. Method A retrospective review was conducted of 122 consecutive patients undergoing surgery following diagnosis of DCIS on percutaneous biopsy at our institution, from 1st January 2017 to 30th November 2019. Histological upgrade was evaluated against clinical, radiological and pathological parameters. Results Of the 122 patients, 31 (25.4%) were upgraded, with 11 (9.1%) having microinvasive disease (T1mi) only. A third of the upgrade group (n = 11) did not have a SNB during the initial surgery. Upgraded patients were younger (median 54yrs v 62yrs P = 0.005), had a higher BMI (median 28.9 v 26 P = 0.02) and more likely to have a palpable lesion (41.9% v 14.9% P &lt; 0.001). Multivariate logistic regression analysis showed that mass detected on ultrasound (OR 3.6 P = 0.04), a palpable lump (OR 5.2 P = 0.03) and finding high grade DCIS on percutaneous biopsy (OR 11.9 P &lt; 0.001) were independently associated with final tumour upgrade. In contrast, patients undergoing vacuum assisted biopsy were less likely to be upgraded after surgery (OR 0.23 P &lt; 0.001). Conclusion Patients that have a higher BMI, palpable lump, mass on ultrasound and percutaneous biopsy showing high grade DCIS are at increased risk of harbouring invasive cancer and should be considered for SNB at initial surgery.

scholarly journals Stromal CD10 and SPARC expression in ductal carcinoma in situ (DCIS) patients predicts disease recurrence

2010 ◽  
Vol 10 (4) ◽  
pp. 391-396 ◽  
Author(s):  
Agnieszka K. Witkiewicz ◽  
Boris Freydin ◽  
Inna Chervoneva ◽  
Magdalena Potoczek ◽  
Wendy Rizzo ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Disease Recurrence ◽  
Sparc Expression

Breast-Conserving Surgery Alone for Ductal Carcinoma In Situ: Factors Associated with Increased Risk of Local Recurrence

2016 ◽  
Vol 24 (5) ◽  
pp. 1221-1226 ◽  
Author(s):  
Alessandra Mele ◽  
Pritesh Mehta ◽  
Priscilla J. Slanetz ◽  
Alexander Brook ◽  
Abram Recht ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Factors Associated ◽  
Increased Risk

scholarly journals Genomic profiling defines variable clonal relatedness between invasive breast cancer and primary ductal carcinoma in situ

2021 ◽  
Author(s):  
Esther H. Lips ◽  
Tapsi Kumar ◽  
Anargyros Megalios ◽  
Lindy L. Visser ◽  
Michael Sheinman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Single Cell ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Invasive Disease ◽  
Clonal Relatedness ◽  
Increased Risk

Pure ductal carcinoma in situ (DCIS) is being diagnosed more frequently through breast screening programmes and is associated with an increased risk of developing invasive breast cancer. We assessed the clonal relatedness of 143 cases of pure DCIS and their subsequent events using a combination of whole exome, targeted and copy number sequencing, supplemented by single cell analysis. Unexpectedly, 18% of all invasive events after DCIS were clonally unrelated to the primary DCIS. Single cell sequencing of selected pairs confirmed our findings. In contrast, synchronous DCIS and invasive disease (n=44) were almost always (93%) clonally related. This challenges the dogma that most invasive events after DCIS represent invasive transformation of the initial DCIS and suggests that DCIS could be an independent risk factor for developing invasive disease as well as a precursor lesion.

21-Gene Assay and Breast Cancer Mortality in Ductal Carcinoma in Situ

2020 ◽  
Author(s):  
Eileen Rakovitch ◽  
Rinku Sutradhar ◽  
Sharon Nofech-Mozes ◽  
Sumei Gu ◽  
Cindy Fong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Breast Cancer Mortality ◽  
Risk Of Death ◽  
Increased Risk ◽  
Gene Assay

Abstract Background The inability to identify individuals with ductal carcinoma in situ (DCIS) who are at risk of breast cancer (BC) mortality have hampered efforts to reduce the over-treatment of DCIS. The 21-gene Recurrence Score (RS) predicts distant metastases for individuals with invasive BC, but its prognostic utility in DCIS is unknown. Methods We performed a population-based analysis of 1,362 individuals of DCIS aged ≤75 years at diagnosis treated with breast-conserving therapy. We examined the association between a high RS (defined a priori as &gt; 25) and the risk of BC mortality by using a propensity score-adjusted model accounting for the competing risk of death from other causes, testing for interactions. All statistical tests were two-sided. Results With 16 years median follow-up, 36 (2.6%) died of BC and 200 (14.7%) died of other causes. The median value of the RS was 15 (range = 0–84); 29.6% of individuals had a high RS. A high RS was associated with an 11-fold increased risk of BC mortality (HR = 11.27 95%CI = 3.00 to 42.33, p&lt;.001 in women ≤50 years of age at diagnosis treated with BCS alone, culminating in a 9.4% (95%CI= 2.3 to 22.5) 20-year risk of BC death. For women with a high RS, treatment with RT was associated with a 71% (HR = 0.29, 95%CI = 0.10 to 0.89. p = .03) relative and a 5% absolute reduction in the 20-year cumulative risk of death from BC. Conclusion The 21-gene RS predicts BC mortality in DCIS and combined with age (≤50 years) at diagnosis can identify individuals for whom RT reduces the risk of death from BC.

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