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Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer.

ABSTRACT: We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N?=?28,003) or stage I-III BC (N?=?275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, separate analyses were performed for stage I BC without adjuvant systemic therapy and by mode of first BC detection. Multivariable models including clinico-pathological and treatment data were created to assess CBC risk prediction performance in DCIS patients. The 10-year cumulative incidence of invasive CBC was 4.8% for DCIS patients (CBC?=?1334). Invasive CBC risk was higher in DCIS patients compared with invasive BC overall (HR?=?1.10, 95% confidence interval (CI)?=?1.04-1.17), and lower compared with stage I BC without adjuvant systemic therapy (HR?=?0.87; 95% CI?=?0.82-0.92). In patients diagnosed ?2011, the HR for invasive CBC was 1.38 (95% CI?=?1.35-1.68) after screen-detected DCIS compared with screen-detected invasive BC, and was 2.14 (95% CI?=?1.46-3.13) when not screen-detected. The C-index was 0.52 (95% CI?=?0.50-0.54) for invasive CBC prediction in DCIS patients. In conclusion, CBC risks are low overall. DCIS patients had a slightly higher risk of invasive CBC compared with invasive BC, likely explained by the risk-reducing effect of (neo)adjuvant systemic therapy among BC patients. For support of clinical decision making more information is needed to differentiate CBC risks among DCIS patients.

SUBMITTER: Giardiello D

PROVIDER: S-EPMC7609533 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer.

Giardiello Daniele D Kramer Iris I Hooning Maartje J MJ Hauptmann Michael M Lips Esther H EH Sawyer Elinor E Thompson Alastair M AM de Munck Linda L Siesling Sabine S Wesseling Jelle J Steyerberg Ewout W EW Schmidt Marjanka K MK

NPJ breast cancer 20201103 1

We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N = 28,003) or stage I-III BC (N = 275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, sep ...[more]

PMID: 33298933

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Project description:Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer where cells restricted to the ducts exhibit an atypical phenotype. Some DCIS lesions are believed to rapidly transit to invasive ductal carcinomas (IDCs), while others remain unchanged. Existing classification systems for DCIS fail to identify those lesions that transit to IDC. We studied gene expression patterns of 31 pure DCIS, 36 pure invasive cancers and 42 cases of mixed diagnosis (invasive cancer with an in situ component) using Agilent Whole Human Genome Oligo Microarrays 44k. Six normal breast tissue samples were also included as controls. qRT-PCR was used for validation. All DCIS and invasive samples could be classified into the intrinsic molecular subtypes defined for invasive breast cancer. Hierarchical clustering establishes that samples group by intrinsic subtype, and not by diagnosis. We observed heterogeneity in the transcriptomes among DCIS of high histological grade and identified a distinct subgroup containing seven of the 31 DCIS samples with gene expression characteristics more similar to advanced tumours. A set of genes independent of grade, ER-status and HER2-status was identified by logistic regression that univariately classified a sample as belonging to this distinct DCIS subgroup. qRT-PCR of single markers clearly separated this DCIS subgroup from the other DCIS, and contains samples from several histopathological and intrinsic molecular subtypes. The genes that differentiate between these two types of DCIS suggest several processes related to the re-organisation of the microenvironment. This raises interesting possibilities for identification of DCIS lesions both with and without invasive characteristics, which potentially could be used in clinical assessment of a woman's risk of progression, and lead to improved management that would avoid the current over- and under-treatment of patients. Breast cancer samples, 31 pure DCIS patients, 36 IDC patients, 42 mixed and 6 normal.

Dataset Information

Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer.

Publications

Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer.

Similar Datasets

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