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The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ.

ABSTRACT: Ductal carcinoma in situ (DCIS) is associated with low rates of mortality. Outcomes are generally assessed in terms of recurrence.Published studies were abstracted from MEDLINE and other sources. We include articles published through January 31, 2009; 10 publications of five randomized controlled trials and 133 publications of 64 observational studies were reviewed.Whole-breast radiation therapy following breast-conserving surgery (BCS) was consistently associated with a reduced incidence of local DCIS recurrence and local invasive carcinoma. Women undergoing mastectomy were less likely than women undergoing lumpectomy with or without radiation to experience local DCIS or invasive recurrence. Tamoxifen use reduced risk of recurrent DCIS or invasive carcinoma.BCS plus radiation and mastectomy appear to yield equivalent outcomes, whereas BCS alone tends to be inferior to mastectomy. Tamoxifen seems helpful in treating DCIS.

SUBMITTER: Kane RL

PROVIDER: S-EPMC5161061 | biostudies-literature | 2010

REPOSITORIES: biostudies-literature

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The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ.

Kane Robert L RL Virnig Beth A BA Shamliyan Tatyana T Wang Shi-Yi SY Tuttle Todd M TM Wilt Timothy J TJ

Journal of the National Cancer Institute. Monographs 20100101 41

<h4>Background</h4>Ductal carcinoma in situ (DCIS) is associated with low rates of mortality. Outcomes are generally assessed in terms of recurrence.<h4>Methods</h4>Published studies were abstracted from MEDLINE and other sources. We include articles published through January 31, 2009; 10 publications of five randomized controlled trials and 133 publications of 64 observational studies were reviewed.<h4>Results</h4>Whole-breast radiation therapy following breast-conserving surgery (BCS) was cons ...[more]

PMID: 20956816

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Project description:BackgroundAge is a known risk factor for recurrence in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS). We explored the relationship between age, other risk factors, and recurrence.MethodsUsing a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010, the association of age and recurrence risk was analyzed using Kaplan-Meier estimates, multivariable analysis, and competing risk multivariable analysis.ResultsOverall, 2996 cases were identified. Median follow-up for those without recurrence was 75 months; 732 were followed for ≥10 years, and 363 (12 %) had recurrence [192 (53 %) DCIS, 160 (44 %) invasive, 11 (3 %) unknown]. Risk of recurrence decreased with age, even after adjustment for eight clinicopathologic variables on multivariable analysis [hazard ratios (HR), with <40 years of age as the reference: 40-49 years, 0.82 (p = 0.36), 50-59 years, 0.46 (p = 0.0005), 60-69 years, 0.50 (p = 0.003), 70-79 years, 0.56 (p = 0.02), ≥80 years, 0.21 (p = 0.0015)]. This association persisted for cohorts with and without radiation therapy. Using competing risk multivariable analysis, the effect of age on invasive recurrence was empirically stronger than for DCIS recurrence. Ten-year invasive recurrence was 16 and 6.5 % in women <40 years of age and women ≥40 years of age, respectively. Only 0.6 % of the population ultimately developed distant disease; those <40 years of age constituted 4.7 % (141/2996) of the population, but 21 % (4/19) of those developed distant disease.ConclusionsThe risk of recurrence of DCIS decreases with age. This effect is particularly strong at the extremes of age and is independent of other clinicopathologic factors. The oldest women are at low risk of recurrence, while the youngest women have a higher overall, and especially invasive, recurrence rate, although mortality remains low. These findings should be incorporated into risk/benefit discussions of treatment options.

Dataset Information

The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ.

Publications

The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ.

Similar Datasets

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