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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2015

01-10-2015 | Breast Oncology

Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years

Authors: Preeti Subhedar, MD, Cristina Olcese, BS, Sujata Patil, PhD, Monica Morrow, MD, FACS, Kimberly J. Van Zee, MS, MD, FACS

Published in: Annals of Surgical Oncology | Issue 10/2015

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Abstract

Background

Randomized trials of radiation after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) found substantial rates of recurrence, with half of the recurrences being invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed and are largely attributed to improvements in systemic therapy. In this study, we examine recurrence rates after BCS for DCIS over 3 decades at one institution.

Methods

We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010. Cox proportional hazard models were used to investigate the association between the treatment period and recurrence, controlling for other variables.

Results

Overall, 363 (12 %) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0–30 years); 732 patients were followed for ≥10 years. The 5-year recurrence rate for the period 1978–1998 was 13.6 versus 6.6 % for the period 1999–2010 [hazard ratio (HR) 0.62, p < 0.0001]. Controlling for age, family history, presentation, nuclear grade, necrosis, number of excisions, margin status, radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p = 0.02) compared to earlier. After stratification by radiation use, association of recurrence with treatment period persisted in those treated without radiation (HR 0.62, p = 0.003).

Conclusions

Recurrence rates for DCIS have fallen over time, with increases in screen detection, negative margins, and use of adjuvant therapies only partially explaining this decrease. The unexplained decline persists in women not receiving radiation, suggesting it is not due to changes in radiation efficacy but may be due to improvements in radiologic detection and pathologic assessment.
Literature
1.
2.
Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):139–41.CrossRefPubMed
3.
Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 2011;12(1):21–9.CrossRefPubMed
4.
Donker M, Litiere S, Werutsky G, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. J Clin Oncol. 2013;31(32):4054–9.CrossRefPubMed
5.
Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88.PubMedCentralCrossRefPubMed
6.
Warnberg F, Garmo H, Emdin S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol. 2014;32(32):3613–8.CrossRefPubMed
7.
Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27(15):2466–73.PubMedCentralCrossRefPubMed
8.
Cabioglu N, Hunt KK, Buchholz TA, et al. Improving local control with breast-conserving therapy: a 27-year single-institution experience. Cancer. 2005;104(1):20–9.CrossRefPubMed
9.
Canavan J, Truong PT, Smith SL, Lu L, Lesperance M, Olivotto IA. Local recurrence in women with stage I breast cancer: declining rates over time in a large, population-based cohort. Int J Radiat Oncol Biol Phys. 2014;88(1):80–6.CrossRefPubMed
10.
Mannino M, Yarnold JR. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother Oncol. 2009;90(1):14–22.CrossRefPubMed
11.
Ernst MF, Voogd AC, Coebergh JW, Poortmans PM, Roukema JA. Using loco-regional recurrence as an indicator of the quality of breast cancer treatment. Eur J Cancer. 2004;40(4):487–93.CrossRefPubMed
12.
Morrow M, Harris JR, Schnitt SJ. Surgical margins in lumpectomy for breast cancer–bigger is not better. N Engl J Med. 2012;367(1):79–82.CrossRefPubMed
13.
Zujewski JA, Harlan LC, Morrell DM, Stevens JL. Ductal carcinoma in situ: trends in treatment over time in the US. Breast Cancer Res Treat. 2011;127(1):251–7.CrossRefPubMed
14.
Collins LC, Achacoso N, Haque R, et al. Risk factors for non-invasive and invasive local recurrence in patients with ductal carcinoma in situ. Breast Cancer Res Treat. 2013;139(2):453–60.PubMedCentralCrossRefPubMed
15.
Early Breast Cancer Trialists’ Collaborative Group, Correa C, McGale P, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;2010(41):162–77.CrossRef
16.
Habel LA, Achacoso NS, Haque R, et al. Declining recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting. Breast Cancer Res. 2009;11(6):R85.PubMedCentralCrossRefPubMed
17.
Solin LJ, Kurtz J, Fourquet A, et al. Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol. 1996;14(3):754–63.PubMed
18.
Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27(32):5319–24.PubMedCentralCrossRefPubMed
19.
Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328(22):1581–6.CrossRefPubMed
20.
Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96(6):443–8.CrossRefPubMed
21.
Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999;353(9169):1993–2000.CrossRefPubMed
22.
Hiramatsu H, Bornstein BA, Recht A, et al. Local recurrence after conservative surgery and radiation therapy for ductal carcinoma in situ: possible importance of family history. Cancer J Sci Am. 1995;1(1):55–61.PubMed
23.
Halasz LM, Sreedhara M, Chen YH, et al. Improved outcomes of breast-conserving therapy for patients with ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2012;82(4):e581–6.CrossRefPubMed
24.
Feeley L, Kiernan D, Mooney T, et al. Digital mammography in a screening programme and its implications for pathology: a comparative study. J Clin Pathol. 2011;64(3):215–9.CrossRefPubMed
25.
Karssemeijer N, Bluekens AM, Beijerinck D, et al. Breast cancer screening results 5 years after introduction of digital mammography in a population-based screening program. Radiology. 2009;253(2):353–8.CrossRefPubMed
26.
Hambly NM, McNicholas MM, Phelan N, Hargaden GC, O’Doherty A, Flanagan FL. Comparison of digital mammography and screen-film mammography in breast cancer screening: a review in the Irish breast screening program. AJR Am J Roentgenol. 2009;193(4):1010–8.CrossRefPubMed
27.
Del Turco MR, Mantellini P, Ciatto S, et al. Full-field digital versus screen-film mammography: comparative accuracy in concurrent screening cohorts. AJR Am J Roentgenol. 2007;189(4):860–6.CrossRefPubMed
28.
Miller KL, Marks LB, Barrier RC Jr, et al. Increased sectioning of pathologic specimens with ductal carcinoma in situ of the breast: are there clinical consequences? Clin Breast Cancer. 2003;4(3):198–202.CrossRefPubMed
29.
Lester SC, Bose S, Chen YY, et al. Protocol for the examination of specimens from patients with ductal carcinoma in situ of the breast. Arch Pathol Lab Med. 2009;133(1):15–25.PubMed
30.
Siziopikou KP. Ductal carcinoma in situ of the breast: current concepts and future directions. Arch Pathol Lab Med. 2013;137(4):462–6.CrossRefPubMed
31.
McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709–15.CrossRefPubMed
32.
Wong JS, Chen YH, Gadd MA, et al. Eight-year update of a prospective study of wide excision alone for small low- or intermediate-grade ductal carcinoma in situ (DCIS). Breast Cancer Res Treat. 2014;143(2):343–50.CrossRefPubMed
33.
Rutter CE, Park HS, Killelea BK, Evans SB. Growing use of mastectomy for ductal carcinoma-in situ of the breast among young women in the United States. Ann Surg Oncol. 2015;22(7):2378–86.CrossRefPubMed
34.
Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.CrossRefPubMed
35.
36.
Rudloff U, Jacks LM, Goldberg JI, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28(23):3762–9.CrossRefPubMed
37.
Sweldens C, Peeters S, van Limbergen E, et al. Local relapse after breast-conserving therapy for ductal carcinoma in situ: a European single-center experience and external validation of the Memorial Sloan-Kettering Cancer Center DCIS nomogram. Cancer J. 2014;20(1):1–7.CrossRefPubMed
38.
Wang F, Li H, Tan PH, et al. Validation of a nomogram in the prediction of local recurrence risks after conserving surgery for Asian women with ductal carcinoma in situ of the breast. Clin Oncol. 2014;26(11):684–91.CrossRef
39.
Collins LC, Achacoso N, Haque R, et al. Risk prediction for local breast cancer recurrence among women with DCIS treated in a community practice: a nested case-control study. Ann Surg Oncol. 2015. doi:10.​1245/​s10434-015-4641-x.
Metadata
Title
Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years
Authors
Preeti Subhedar, MD
Cristina Olcese, BS
Sujata Patil, PhD
Monica Morrow, MD, FACS
Kimberly J. Van Zee, MS, MD, FACS
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4740-8

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