1
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ElSherif A, Freyvogel Ramirez M, Moore EC, Dietz JR, Tu C, Valente SA. Mastectomy margins for ductal carcinoma-in-situ (DCIS): 18 Years of follow-up. Am J Surg 2023; 226:646-651. [PMID: 37481406 DOI: 10.1016/j.amjsurg.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND In patients undergoing mastectomy for ductal carcinoma in situ (DCIS), the significance of a positive or close (<2 mm) margin and associated recurrence risk is unclear. The study sought to evaluate risk of recurrence in relation to the mastectomy surgical margin. METHODS A single institution retrospective review of patients with DCIS who underwent mastectomy between 2000 and 2010 was performed. Patient demographics, tumor biology, margin status and adjuvant therapy were recorded. The incidence of local recurrence (LR), distant metastasis were analyzed. RESULTS A total of 282 patients with DCIS were identified. Overall, 12.3% of patients had a pathological positive/close margin (n = 9 tumor on ink and n = 36 <2 mm). Adjuvant radiation was administered to 11 patients with a positive or close margin. At a median follow-up of 12 years, LR was 3.4% (n = 10). None of the patients with LR had a positive or close margin. Additionally, none of the patients who received radiation developed LR. CONCLUSION Risk of recurrence after mastectomy for DCIS is low and appears to be unrelated to margin status or the use of radiation therapy.
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MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy
- Follow-Up Studies
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Retrospective Studies
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/surgery
- Margins of Excision
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Affiliation(s)
- Ayat ElSherif
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Mary Freyvogel Ramirez
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Edwina C Moore
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, United States
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Stephanie A Valente
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
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2
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Fitzpatrick SE, Eaton M, McLeay W, Dean NR. Outcomes of DCIS treated with breast conserving surgery without radiotherapy on recurrence, survival, and health-related quality of life. ANZ J Surg 2023; 93:2208-2213. [PMID: 37062870 DOI: 10.1111/ans.18459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/03/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Sector resection for Ductal Carcinoma in Situ (DCIS) allows wide excision without compromising breast shape. There are concerns that radiotherapy for some DCIS after sector resection is unnecessary and reduces patient satisfaction and quality of life without affecting survival. This study aimed to investigate whether women with DCIS managed with sector resection without radiotherapy had acceptable rates of recurrence and health-related quality of life outcomes. METHODS Retrospective study of patients who underwent sector resection for DCIS without adjuvant radiotherapy from 1992 to 2021. Tumour size, grade, necrosis, margins, follow up and time to ipsilateral recurrence was recorded. Patients were posted a BREAST-Q to assess health-related quality of life. RESULTS One hundred and thirty-eight patients were treated for pure DCIS by two surgeons from 1992 to 2018. One hundred and sixteen patients underwent sector resection, 22 had mastectomy. Average age 61 years. Mean follow up 9.14 years. Recurrence rate after sector resection was 18.97%. 55% were DCIS. Annualized recurrence rate was 2.07%. There were no cancer-related deaths. BREAST-Q completion rate was 44%. Satisfaction with breasts, physical, psychosocial, and sexual well-being scores were significantly higher than normative Australian values and a mixed cohort of women who underwent breast conserving surgery with radiotherapy. CONCLUSION DCIS can be safely managed with sector resection without radiotherapy and regular long-term follow up. This approach results in low annualized recurrence rates, high levels patient satisfaction and health-related quality of life and should be considered a safe alternative for patients with DCIS to minimize morbidity without affecting cancer survival.
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MESH Headings
- Female
- Humans
- Middle Aged
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy, Segmental/methods
- Mastectomy/methods
- Treatment Outcome
- Retrospective Studies
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Quality of Life
- Follow-Up Studies
- Australia/epidemiology
- Radiotherapy, Adjuvant
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/surgery
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Affiliation(s)
- Siobhan Elizabeth Fitzpatrick
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael Eaton
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - William McLeay
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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3
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Jatoi I, Shaaban AM, Jou E, Benson JR. The Biology and Management of Ductal Carcinoma in Situ of the Breast. Curr Probl Surg 2023; 60:101361. [PMID: 37596033 DOI: 10.1016/j.cpsurg.2023.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/27/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - Abeer M Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham and Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Eric Jou
- Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - John R Benson
- Addenbrooke's Hospital, University of Cambridge, Cambridge; School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
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4
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Gram EG, Manso TFR, Heleno B, Siersma V, Á Rogvi J, Brodersen JB. The long-term psychosocial consequences of screen-detected ductal carcinoma in situ and invasive breast cancer. Breast 2023; 70:41-48. [PMID: 37307773 DOI: 10.1016/j.breast.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Ductal carcinoma in situ (DCIS) is a risk factor for invasive breast cancer (IBC). The prognosis of DCIS is considerably better than for IBC, yet women do not distinguish between the threat. We aimed to compare the psychosocial consequences of screen-detected DCIS and IBC, and to examine this comparison over time. METHODS We surveyed a Danish mammography-screening cohort from 2004 to 2018. We assessed outcomes at six-time points: baseline, 1, 6, 18, 36 months, and 14 years after the screening. We measured psychosocial consequences with the Consequences Of Screening - Breast Cancer (COS-BC): a condition-specific questionnaire that is psychometrically validated and encompasses 14 psychosocial dimensions. We used weighted linear models with generalized estimating equations to compare responses between groups. We used a 1% level of significance. RESULTS 170 out of 1309 women were diagnosed with breast cancer (13.0%). 23 were diagnosed with DCIS (13.5%) and 147 with IBC (86.5%). From baseline to six months after diagnosis, there were no significant differences between women with DCIS and IBC. However, mean scores indicated that IBC generally was more affected than DCIS. After six months, we observed that women with DCIS and IBC might be affected differently in the long term; mean scores and mean differences showed that IBC were more affected on some scales, while DCIS were on others. CONCLUSION Overall, the DCIS and IBC experienced similar levels of psychosocial consequences. Women might benefit from renaming DCIS to exclude cancer nomenclature.
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Affiliation(s)
- Emma Grundtvig Gram
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Region Zealand, Denmark.
| | - Túlia Filipa Roberto Manso
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Bruno Heleno
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Volkert Siersma
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Á Rogvi
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Region Zealand, Denmark; Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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5
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Balac N, Tungate RM, Jeong YJ, MacDonald H, Tung L, Schechter NR, Larsen L, Sener SF, Lang JE, Brownson KE. Is palpable DCIS more aggressive than screen-detected DCIS? Surg Open Sci 2022; 11:83-87. [PMID: 36589700 PMCID: PMC9798160 DOI: 10.1016/j.sopen.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background Palpable ductal carcinoma in-situ (pDCIS) is a subset of DCIS presenting with a clinical mass. We hypothesized pDCIS would have more aggressive clinical and pathological features, and higher rates of recurrence and upgrade to invasive disease compared to screen-detected DCIS. Materials and methods We performed a retrospective analysis of female patients (age 28-76) with DCIS on core-needle biopsy. pDCIS patients had a physician documented palpable mass prior to initial biopsy. Descriptive statistics were performed to compare groups. Results This study included 83 patients, 26 had pDCIS and 57 had screen-detected DCIS. Mean duration of follow-up was 49.4 months. pDCIS patients had significantly larger lesions (p = 0.03) which were more frequently biopsied via ultrasound (p = 0.002). In multivariate analysis, pDCIS was associated with ultrasound guided core needle biopsy, size of DCIS >2 cm, and comedo pattern (p = 0.001, p = 0.007 and p = 0.022, respectively). 7.7 % of pDCIS cases versus 3.5 % of screen-detected cases were upgraded to invasive cancer (p = 0.59). There was no difference in local recurrence (p = 0.55) between groups. Neither group experienced regional or distant recurrence. Conclusions pDCIS was associated with some aggressive pathologic and clinical features and was more frequently diagnosed by ultrasound guided core-needle biopsy than screen-detected DCIS. However, there was no significant difference in rate of recurrence or upgrade to invasive disease between groups. Key message Although pDCIS was associated with some aggressive pathologic and clinical features, there was no significant difference in rate of recurrence or upgrade to invasive disease compared to screen-detected DCIS.
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Affiliation(s)
- Nina Balac
- Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA,Corresponding author at: 1245 Park Avenue Apt 7A, New York, NY 10128, USA.
| | - Robert M. Tungate
- Department of Internal Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Young Ju Jeong
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | | | - Lily Tung
- Department of Trauma Surgery and Critical Care, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada
| | - Naomi R. Schechter
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033, USA
| | - Linda Larsen
- Department of Radiology, Division of Women's Imaging, University of Southern California, Los Angeles, CA 90033, USA
| | - Stephen F. Sener
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA,Department of Surgery, LAC+USC (LA County) Medical Center, Los Angeles, CA 90033, USA
| | - Julie E. Lang
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA,Department of Surgery, LAC+USC (LA County) Medical Center, Los Angeles, CA 90033, USA
| | - Kirstyn E. Brownson
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA,Department of Surgery, LAC+USC (LA County) Medical Center, Los Angeles, CA 90033, USA
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6
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Casasent AK, Almekinders MM, Mulder C, Bhattacharjee P, Collyar D, Thompson AM, Jonkers J, Lips EH, van Rheenen J, Hwang ES, Nik-Zainal S, Navin NE, Wesseling J. Learning to distinguish progressive and non-progressive ductal carcinoma in situ. Nat Rev Cancer 2022; 22:663-678. [PMID: 36261705 DOI: 10.1038/s41568-022-00512-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a non-invasive breast neoplasia that accounts for 25% of all screen-detected breast cancers diagnosed annually. Neoplastic cells in DCIS are confined to the ductal system of the breast, although they can escape and progress to invasive breast cancer in a subset of patients. A key concern of DCIS is overtreatment, as most patients screened for DCIS and in whom DCIS is diagnosed will not go on to exhibit symptoms or die of breast cancer, even if left untreated. However, differentiating low-risk, indolent DCIS from potentially progressive DCIS remains challenging. In this Review, we summarize our current knowledge of DCIS and explore open questions about the basic biology of DCIS, including those regarding how genomic events in neoplastic cells and the surrounding microenvironment contribute to the progression of DCIS to invasive breast cancer. Further, we discuss what information will be needed to prevent overtreatment of indolent DCIS lesions without compromising adequate treatment for high-risk patients.
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Affiliation(s)
- Anna K Casasent
- Department of Genetics, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Charlotta Mulder
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Jos Jonkers
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jacco van Rheenen
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Serena Nik-Zainal
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Nicholas E Navin
- Department of Genetics, MD Anderson Cancer Center, Houston, TX, USA
- Department of Bioinformatics, MD Anderson Cancer Center, Houston, TX, USA
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
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7
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Mazumdar A, Jain S, Jain S, Bose SM. Management of Early Breast Cancer – Surgical Aspects. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Schousboe JT, Sprague BL, Abraham L, O'Meara ES, Onega T, Advani S, Henderson LM, Wernli KJ, Zhang D, Miglioretti DL, Braithwaite D, Kerlikowske K. Cost-Effectiveness of Screening Mammography Beyond Age 75 Years : A Cost-Effectiveness Analysis. Ann Intern Med 2022; 175:11-19. [PMID: 34807717 PMCID: PMC9621600 DOI: 10.7326/m20-8076] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The cost-effectiveness of screening mammography beyond age 75 years remains unclear. OBJECTIVE To estimate benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years according to comorbidity burden. DESIGN Markov microsimulation model. DATA SOURCES SEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium. TARGET POPULATION U.S. women aged 65 to 90 years in groups defined by Charlson comorbidity score (CCS). TIME HORIZON Lifetime. PERSPECTIVE National health payer. INTERVENTION Screening mammography to age 75, 80, 85, or 90 years. OUTCOME MEASURES Breast cancer death, survival, and costs. RESULTS OF BASE-CASE ANALYSIS Extending biennial mammography from age 75 to 80 years averted 1.7, 1.4, and 1.0 breast cancer deaths and increased days of life gained by 5.8, 4.2, and 2.7 days per 1000 women for comorbidity scores of 0, 1, and 2, respectively. Annual mammography beyond age 75 years was not cost-effective, but extending biennial mammography to age 80 years was ($54 000, $65 000, and $85 000 per quality-adjusted life-year [QALY] gained for women with CCSs of 0, 1, and ≥2, respectively). Overdiagnosis cases were double the number of deaths averted from breast cancer. RESULTS OF SENSITIVITY ANALYSIS Costs per QALY gained were sensitive to changes in invasive cancer incidence and shift of breast cancer stage with screening mammography. LIMITATION No randomized controlled trials of screening mammography beyond age 75 years are available to provide model parameter inputs. CONCLUSION Although annual mammography is not cost-effective, biennial screening mammography to age 80 years is; however, the absolute number of deaths averted is small, especially for women with comorbidities. Women considering screening beyond age 75 years should weigh the potential harms of overdiagnosis versus the potential benefit of averting death from breast cancer. PRIMARY FUNDING SOURCE National Cancer Institute and National Institutes of Health.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Bloomington, and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota (J.T.S.)
| | - Brian L Sprague
- Departments of Surgery and Radiology, The University of Vermont, Burlington, Vermont (B.L.S.)
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.)
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.)
| | - Tracy Onega
- Department of Population Health Sciences and Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah (T.O.)
| | - Shailesh Advani
- Department of Oncology, School of Medicine, Georgetown University, Washington, DC, and Terasaki Institute for Biomedical Innovation, Los Angeles, California (S.A.)
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (L.M.H.)
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.)
| | - Dongyu Zhang
- Cancer Control and Population Sciences Program and Department of Epidemiology, University of Florida, Gainesville, Florida (D.Z.)
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, California, and Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.L.M.)
| | - Dejana Braithwaite
- Cancer Control and Population Sciences Program, Department of Epidemiology, and Institute on Aging, University of Florida, Gainesville, Florida (D.B.)
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics and Department of Veterans Affairs (VA) Division of General Internal Medicine, University of California, San Francisco, San Francisco, California (K.K.)
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9
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Yoo TK, Park SH, Do Han K, Chae BJ. Cardiovascular events and mortality in a population-based cohort initially diagnosed with ductal carcinoma in situ. BMC Cancer 2021; 21:735. [PMID: 34174850 PMCID: PMC8236151 DOI: 10.1186/s12885-021-08494-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/09/2021] [Indexed: 01/05/2023] Open
Abstract
Background Ductal carcinoma in situ (DCIS) patients are usually diagnosed through cancer screening programs, suggesting a healthy user effect. In this population-based cohort, we assessed the risk of cardiovascular events and mortality in DCIS patients. Methods Using the Korean National Health Insurance Service database, 13,740 women, who were initially diagnosed with DCIS between 2007 and 2013, were analyzed. A control group was matched according to age and the year of diagnosis at a 3:1 ratio (n = 41,220). Follow-up was performed until 2016. Subgroup analysis was performed according to the subsequent diagnosis of invasive breast cancer within 1 year: pure DCIS and DCIS+Invasive group. Results DCIS patients were more likely to have underlying diseases, higher incomes, and to live in urban districts compared to the control group. Women diagnosed of DCIS had lower myocardial infarct risk (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.46–0.90) and lower stroke risk (HR 0.77; 95% CI 0.60–0.98) compared to the control group. This trend of lower risk was sustained after adjusting for age, income, residence and comorbidities. The mortality rate was similar between the control group and pure DCIS patients but was higher in the DCIS+Invasive group (HR 1.63; 95% CI 1.34–1.98). However, after adjusting for age, income, residence and comorbidities, mortality did not differ between the control group and DCIS+Invasive group (HR 0.99; 95% CI 0.78–1.24). Conclusions DCIS patients were at lower risk for MI and stroke compared to a control group despite a higher rate of comorbidities, which may reflect changes in health behaviour. The importance of managing pre-existing comorbidities along with DCIS treatment should be emphasized. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08494-0.
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Affiliation(s)
- Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Republic of Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Kangnam-Gu, Seoul, 06531, South Korea.
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10
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Heart-related mortality after postoperative breast irradiation in patients with ductal carcinoma in situ in the contemporary radiotherapy era. Sci Rep 2021; 11:2790. [PMID: 33531527 PMCID: PMC7854728 DOI: 10.1038/s41598-021-82263-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022] Open
Abstract
Although radiation-induced cardiotoxicity has been addressed, its prognostic relevance to modern radiotherapy (RT) techniques is unclear. This study assessed the impact of adjuvant RT on heart-related deaths in patients with ductal carcinoma in situ. Patients who underwent adjuvant RT after breast-conserving surgery between 1988 and 2008 were identified from the Surveillance, Epidemiology, and End Results database. Kaplan‒Meier and competing risks analyses were conducted after propensity score-matching according to tumor laterality. A total of 41,526 propensity-matched patients were identified (n = 20,763 for either left- or right-sided tumor). In the analysis of the cumulative incidence of heart-related mortality events, there was a greater risk increment in the left-sided group over the first to second decades after RT in patients aged ≤ 50 years (P = 0.048). Competing risks analysis of the young patients showed that left-sided RT was associated with higher heart-related mortality rates (Grey’s test, P = 0.049). The statistical significance remained after adjusting for other covariates (subdistribution hazard ratio 2.35; 95% confidence interval 1.09‒5.10). Regarding the intrinsic effect of modern RT techniques, further strategies to reduce heart-related risks are needed for young patients. Close surveillance within an earlier follow-up period should be considered for these patients in clinics.
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11
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Liu TT, Li XF, Wang L, Yang JL. CD133 expressionand clinicopathologic significance in benign and malignant breast lesions. Cancer Biomark 2021; 28:293-299. [PMID: 32390595 DOI: 10.3233/cbm-190196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE CD133 is the molecular marker of normal stem cells and progenitor cells and also confirmed as a marker for cancer stem cells in various tumors. The aim of this study is to examine the expression of CD133 and assess its clinicopathologic significance in benign and malignant breast lesions. METHODS We analyzed the distribution of CD133 positive cells in breast usual ductal hyperplasia, atypical ductal hyperplasia (ADH), breast ductal carcinoma in situ (DCIS), and invasive breast carcinomas. We then explored the relationship between the CD133 expression and clinicopathologic features using immuno-histochemical staining. RESULTS We found that CD133 is not expressed in the cells of normal breast tissue, but the expression rate increased with progression of lesions from usual hyperplasia, through atypical ductal hyperplasia, ductal carcinoma in situ and invasive carcinoma. The positive expression rate of CD133 in breast invasive ductal carcinoma correlated to histological grade, cancer stage, nodal status, metastasis, recurrence, event-free survival and overall survival. There was no significant correlation between CD133 expression and factors such as age, postmenopausal status, histological type, tumor size, estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 expression. CONCLUSION CD133 may play an important role in the occurrence and development of breast cancer. CD133 positive breast cancer cells are closely related to invasiveness and its expression may predict a poor prognosis.
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Affiliation(s)
- Ting Ting Liu
- Department of Pathology, Kunming General Hospital, Kunming, Yunnan, China.,Department of Internal Medicine, West China Medical Center, Sichuan University, Chengdu, Sichuan, China
| | - Xue Feng Li
- Department of Pathology, Kunming General Hospital, Kunming, Yunnan, China
| | - Li Wang
- Department of Pathology, Kunming General Hospital, Kunming, Yunnan, China
| | - Ju Lun Yang
- Department of Pathology, Kunming General Hospital, Kunming, Yunnan, China
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12
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Abstract
IMPORTANCE It is not clear to what extent a diagnosis of ductal carcinoma in situ (DCIS) impacts a woman's lifetime risk of dying of breast cancer. Under ideal circumstances, treatment will eliminate the risk of invasive ipsilateral recurrence and prevent subsequent mortality from breast cancer. The risk of dying of breast cancer after a diagnosis of DCIS had not been compared with that of women without cancer in the general population. OBJECTIVE To determine the risk of death from breast cancer in a large cohort of patients treated for DCIS and to compare the risk with that of women in the general population. DESIGN, SETTING, AND PARTICIPANTS This cohort study included data for women who had first primary DCIS diagnosed between 1995 and 2014 from the Surveillance, Epidemiology and End Results (SEER) registries database. Women with DCIS underwent surgical treatment, and approximately half also received radiotherapy. These women were followed from the date of DCIS diagnosis until death from breast cancer or date of last follow-up. Women in the general population without breast cancer were analyzed as controls. Follow-up information was available up to December 2016. The data were analyzed in March 2020. EXPOSURES Patients with DCIS who underwent surgical treatment. MAIN OUTCOMES AND MEASURES Breast cancer death was the main outcome. Standardized mortality ratios were estimated by comparing deaths from breast cancer among women diagnosed with DCIS with expected deaths from breast cancer among women in the general population who did not have cancer. Expected probability of death from breast cancer in the general population was calculated by an incidence-based mortality approach using standardized SEER-based incidence and case-fatality rates. Probability of breast cancer death was estimated based on the assumption that a cancer-free control was cancer free on the date the woman with DCIS was diagnosed and was studied until the end of follow-up. RESULTS A total of 144 524 women diagnosed with first primary DCIS were included (mean [SD] age at diagnosis, 57.4 [11.0] years). There were 1540 deaths from breast cancer in the cohort. Based on SEER-based incidence and case-fatality rates, 458 breast cancer deaths were expected in an equivalent number of cancer-free women from the general population with equal follow-up. The standardized mortality ratio for death from breast cancer among women with DCIS was 3.36 (95% CI, 3.20-3.53). The elevated risk of death persisted more than 15 years after diagnosis. CONCLUSIONS AND RELEVANCE In the population studied, the risk of dying of breast cancer was increased 3-fold after a diagnosis of DCIS. This suggests that our current treatment focus on preventing invasive recurrence is insufficient to eliminate all deaths from breast cancer after DCIS.
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Affiliation(s)
- Vasily Giannakeas
- Women’s College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Victoria Sopik
- Women’s College Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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13
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Ductal Carcinoma In Situ—Pathological Considerations. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Obeng-Gyasi S, Timsina L, Bhattacharyya O, Fisher CS, Haggstrom DA. Breast Cancer Presentation, Surgical Management and Mortality Across the Rural-Urban Continuum in the National Cancer Database. Ann Surg Oncol 2020; 27:1805-1815. [PMID: 32206955 DOI: 10.1245/s10434-020-08376-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to examine differences in presentation, surgical management, and mortality among breast cancer patients in the National Cancer Database (NCDB) based on area of residence. METHODS The NCDB was queried for women with a diagnosis of breast cancer from 1 January 2004-31 December 2015. The data were divided by metropolitan (large, medium, small) and non-metropolitan (urban, rural) status. RESULTS Cancer stage increased with rurality (p < 0.0001). Residency in a large metropolitan area was associated with increased breast reconstruction rates (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.19-1.30) and reduced overall mortality (hazard ratio 0.92, 95% CI 0.89-0.95) compared with rural areas. There was no difference in mastectomy use among small metropolitan (OR 1.03, 95% CI 1.01-1.04), urban (OR 0.99, 95% CI 0.98-1), and rural areas (OR 1.05, 95% CI 1.01-1.07) compared with large metropolitan areas. CONCLUSIONS Across the rural-urban continuum in the NCDB, stage of cancer presentation increased with rurality. Conversely, residency in a large metropolitan area was associated with higher reconstruction rates and a reduction in overall mortality. Future studies should evaluate factors contributing to advanced disease presentation and lower reconstruction rates among rural breast cancer patients.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. .,Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA.
| | - Lava Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Carla S Fisher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David A Haggstrom
- VA Health Services Research and Development Center for Health Information and Communication, Indianapolis, IN, USA.,Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
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15
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I. Mohammed S, Utturkar S, Lee M, Yang HH, Cui Z, Atallah Lanman N, Zhang G, Ramos Cardona XE, Mittal SK, Miller MA. Ductal Carcinoma In Situ Progression in Dog Model of Breast Cancer. Cancers (Basel) 2020; 12:cancers12020418. [PMID: 32053966 PMCID: PMC7072653 DOI: 10.3390/cancers12020418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/25/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
The mechanisms that drive ductal carcinoma in situ (DCIS) progression to invasive cancer are not clear. Studying DCIS progression in humans is challenging and not ethical, thus necessitating the characterization of an animal model that faithfully resembles human disease. We have characterized a canine model of spontaneous mammary DCIS and invasive cancer that shares histologic, molecular, and diagnostic imaging characteristics with DCIS and invasive cancer in women. The purpose of the study was to identify markers and altered signaling pathways that lead to invasive cancer and shed light on early molecular events in breast cancer progression and development. Transcriptomic studies along the continuum of cancer progression in the mammary gland from healthy, through atypical ductal hyperplasia (ADH), DCIS, and invasive carcinoma were performed using the canine model. Gene expression profiles of preinvasive DCIS lesions closely resemble those of invasive carcinoma. However, certain genes, such as SFRP2, FZD2, STK31, and LALBA, were over-expressed in DCIS compared to invasive cancer. The over-representation of myoepithelial markers, epithelial-mesenchymal transition (EMT), canonical Wnt signaling components, and other pathways induced by Wnt family members distinguishes DCIS from invasive. The information gained may help in stratifying DCIS as well as identify actionable targets for primary and tertiary prevention or targeted therapy.
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Affiliation(s)
- Sulma I. Mohammed
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
- Correspondence: ; Tel.: +1-765-494-9948; Fax: +1-765-494-9830
| | - Sagar Utturkar
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - Maxwell Lee
- High Dimension Data Analysis Group, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20852, USA; (M.L.); (H.H.Y.)
| | - Howard H. Yang
- High Dimension Data Analysis Group, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20852, USA; (M.L.); (H.H.Y.)
| | - Zhibin Cui
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
| | - Nadia Atallah Lanman
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - GuangJun Zhang
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - Xavier E. Ramos Cardona
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
| | - Suresh K. Mittal
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - Margaret A. Miller
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
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16
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Risk factors for ductal carcinoma in situ of the breast in the UK Biobank cohort study. Cancer Epidemiol 2019; 64:101648. [PMID: 31837535 DOI: 10.1016/j.canep.2019.101648] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/10/2019] [Accepted: 11/22/2019] [Indexed: 01/12/2023]
Abstract
Ductal carcinoma in situ of the breast (DCIS) is considered to be a non-obligate precursor of invasive breast cancer (IBC). This suggests that risk factors for DCIS should be a subset of those for IBC. To this end, we investigated whether demographic, lifestyle, and reproductive factors that have been linked to IBC risk are also associated with DCIS risk. This study was conducted in 263,788 women aged 40-69 years at enrolment into the UK Biobank population-based cohort. Information on demographic, reproductive and health factors was collected at baseline using computerized questionnaires, while incident DCIS was ascertained through linkage to UK cancer registries. Age-adjusted and multivariable hazard ratios were estimated using Cox proportional hazards models in the total sample and by menopausal status. During an average of 7 years of follow-up, 1,016 women developed DCIS. Multivariable analysis indicated that age, physical activity, height, family history of breast cancer, menopausal status, parity, and years between menarche and first live birth had associations with DCIS risk. Among post-menopausal women not using hormone replacement therapy, body mass index ≥30 kg/m2 was associated with increased DCIS risk. This study, the largest to date including both pre-menopausal and post-menopausal women, confirms previous findings indicating correspondence between risk factors for DCIS and IBC and highlights the potential contribution to DCIS risk of anthropometric measures not previously reported to be associated with the disease, such as height and BMI amongst post-menopausal women.
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17
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Mullooly M, Withrow DR, Curtis RE, Fan S, Liao LM, Pfeiffer RM, de González AB, Gierach GL. Association of lifestyle and clinical characteristics with receipt of radiotherapy treatment among women diagnosed with DCIS in the NIH-AARP Diet and Health Study. Breast Cancer Res Treat 2019; 179:445-457. [PMID: 31625031 DOI: 10.1007/s10549-019-05436-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The long-term risks and benefits of radiotherapy for ductal carcinoma in situ (DCIS) remain unclear. Recent data from the Surveillance, Epidemiology and End Results (SEER) registries showed that DCIS-associated radiotherapy treatment significantly increased risk of second non-breast cancers including lung cancer. To help understand those observations and whether breast cancer risk factors are related to radiotherapy treatment decision-making, we examined associations between lifestyle and clinical factors with DCIS radiotherapy receipt. METHODS Among 1628 participants from the NIH-AARP Diet and Health Study, diagnosed with incident DCIS (1995-2011), we examined associations between lifestyle and clinical factors with radiotherapy receipt. Radiotherapy and clinical information were ascertained from state cancer registries. Odds ratios (ORs) and 95% confidence intervals (CIs) for radiotherapy receipt (yes/no) were estimated from multivariable logistic regression. RESULTS Overall, 45% (n = 730) received radiotherapy. No relationships were observed for most lifestyle factors and radiotherapy receipt, including current smoking (OR 0.97, 95%CI 0.70, 1.34). However positive associations were observed for moderate alcohol consumption and infrequent physical activity. The strongest associations were observed for radiotherapy receipt and more recent diagnoses (2005-2011 vs. 1995-1999; OR 1.60, 95%CI 1.14, 2.25), poorly versus well-differentiated tumors (OR 1.69, 95%CI 1.16, 2.46) and endocrine therapy (OR 3.37, 95%CI 2.56, 4.44). CONCLUSIONS Clinical characteristics were the strongest determinants of DCIS radiotherapy. Receipt was largely unrelated to lifestyle factors suggesting that the previously observed associations in SEER were likely not confounded by these lifestyle factors. Further studies are needed to understand mechanisms driving radiotherapy-associated second malignancies following DCIS, to identify prevention opportunities for this growing population.
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Affiliation(s)
- Maeve Mullooly
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Diana R Withrow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Shaoqi Fan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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18
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Ward WH, DeMora L, Handorf E, Sigurdson ER, Ross EA, Daly JM, Aggon AA, Bleicher RJ. Preoperative Delays in the Treatment of DCIS and the Associated Incidence of Invasive Breast Cancer. Ann Surg Oncol 2019; 27:386-396. [PMID: 31562602 PMCID: PMC6949196 DOI: 10.1245/s10434-019-07844-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Indexed: 12/17/2022]
Abstract
Background Although treatment delays have been associated with survival impairment for invasive breast cancer, this has not been thoroughly investigated for ductal carcinoma in situ (DCIS). With trials underway to assess whether DCIS can remain unresected, this study was performed to determine whether longer times to surgery are associated with survival impairment or increased invasion. Methods A population-based study of prospectively collected national data derived from women with a clinical diagnosis of DCIS between 2004 and 2014 was conducted using the National Cancer Database. Overall survival (OS) and presence of invasion were assessed as functions of time by evaluating five intervals (≤ 30, 31–60, 61–90, 91–120, 121–365 days) between diagnosis and surgery. Subset analyses assessed those having pathologic DCIS versus invasive cancer on final pathology. Results Among 140,615 clinical DCIS patients, 123,947 had pathologic diagnosis of DCIS and 16,668 had invasive ductal carcinoma. For all patients, 5-year OS was 95.8% and unadjusted median delay from diagnosis to surgery was 38 days. With each delay interval increase, added relative risk of death was 7.4% (HR 1.07; 95% CI 1.05–1.10; P < 0.001). On final pathology, 5-year OS for noninvasive patients was 96.0% (95% CI 95.9–96.1%) versus 94.9% (95% CI 94.6–95.3%) for invasive patients. Increasing delay to surgery was an independent predictor of invasion (OR 1.13; 95% CI 1.11–1.15; P < 0.001). Conclusions Despite excellent OS for invasive and noninvasive cohorts, invasion was seen more frequently as delay increased. This suggests that DCIS trials evaluating nonoperative management, which represents infinite delay, require long term follow up to ensure outcomes are not compromised. Electronic supplementary material The online version of this article (10.1245/s10434-019-07844-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- William H Ward
- Department of Surgery, Naval Medical Center, Portsmouth, VA, USA
| | - Lyudmila DeMora
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Handorf
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elin R Sigurdson
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric A Ross
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - John M Daly
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Allison A Aggon
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Liu Y, West R, Weber JD, Colditz GA. Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ. Cancer 2019; 125:3225-3233. [PMID: 31120565 PMCID: PMC6717007 DOI: 10.1002/cncr.32200] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/22/2019] [Accepted: 04/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND General populations of black women have a higher risk of developing breast cancer negative for both estrogen receptor (ER) and progesterone receptor (PR) in comparison with white counterparts. Racial differences remain unknown in the risk of developing aggressive invasive breast cancer (IBC) that is characterized by negativity for both ER and PR (ER-PR-) or higher 21-gene recurrence scores after ductal carcinoma in situ (DCIS). METHODS This study identified 163,892 women (10.5% black, 9.8% Asian, and 8.6% Hispanic) with incident DCIS between 1990 and 2015 from the Surveillance, Epidemiology, and End Results data sets. Cox proportional hazards regression was used to estimate hazards ratios (HRs) of subsequent IBC classified by the hormone receptor status and 21-gene recurrence scores. RESULTS During a median follow-up of 90 months, 8333 women developed IBC. In comparison with white women, the adjusted HR of subsequent ER-PR- breast cancer was 1.86 (95% confidence interval [CI], 1.57-2.20) for black women (absolute 10-year difference, 2.2%) and 1.40 (95% CI, 1.14-1.71) for Asian women (absolute 10-year difference, 0.4%); this was stronger than the associations for ER+ and/or PR+ subtypes (Pheterogeneity = .0004). The 21-gene recurrence scores of subsequent early-stage, ER+ IBCs varied by race/ethnicity (Pheterogeneity = .057); black women were more likely than white women to have a recurrence score of 26 or higher (HR, 1.38; 95% CI, 1.00-1.92). No significant difference was observed in the risks of subsequent IBC subtypes for Hispanic women. CONCLUSIONS Black and Asian women with DCIS had higher risks of developing biologically aggressive IBC than white counterparts. This should be considered in treatment decisions for black and Asian patients with DCIS.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Asian/statistics & numerical data
- Breast Neoplasms/ethnology
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Incidence
- Male
- Middle Aged
- Neoplasm Invasiveness
- Neoplasms, Second Primary/ethnology
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Proportional Hazards Models
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Risk
- SEER Program
- United States/epidemiology
- White People/statistics & numerical data
- Young Adult
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Affiliation(s)
- Ying Liu
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisMissouri
- Alvin J. Siteman Cancer CenterBarnes‐Jewish Hospital and Washington University School of MedicineSt. LouisMissouri
| | - Robert West
- Department of PathologyStanford University School of MedicineStanfordCalifornia
| | - Jason D. Weber
- Alvin J. Siteman Cancer CenterBarnes‐Jewish Hospital and Washington University School of MedicineSt. LouisMissouri
- Division of Molecular Oncology, Department of MedicineWashington University School of MedicineSt. LouisMissouri
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisMissouri
- Alvin J. Siteman Cancer CenterBarnes‐Jewish Hospital and Washington University School of MedicineSt. LouisMissouri
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Ekenga CC, Wang X, Pérez M, Schootman M, Jeffe DB. A Prospective Study of Weight Gain in Women Diagnosed with Early-Stage Invasive Breast Cancer, Ductal Carcinoma In Situ, and Women Without Breast Cancer. J Womens Health (Larchmt) 2019; 29:524-533. [PMID: 31460829 DOI: 10.1089/jwh.2018.7638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Weight gain after breast cancer has been associated with recurrence and mortality. We therefore examined factors associated with ≥5% weight gain over 2-year follow-up of a cohort of newly diagnosed early-stage invasive breast cancer (EIBC) and ductal carcinoma in situ (DCIS) patients and age-matched controls without a breast cancer history. Materials and Methods: We interviewed participants 4-6 weeks after definitive surgical treatment (patients) or a negative/benign screening mammogram (controls). Multivariable logistic regression models were used to identify socioeconomic, psychosocial, and treatment factors associated with ≥5% weight gain over 2-year follow-up. Results: Overall, 88 (24%) of 362 EIBC patients, 31 (17%) of 178 DCIS patients, and 82 (15%) of 541 controls had ≥5% weight gain during follow-up. EIBC patients were more likely to experience ≥5% weight gain than DCIS patients (Odds ratio [OR] = 2.16; 95% confidence interval [95% CI] = 1.19-3.95) and controls (OR = 1.76; 95% CI = 1.23-2.51). Among EIBC patients, older patients (OR = 0.96; 95% CI = 0.93-0.99), patients who underwent endocrine therapy (OR = 0.43; 95% CI = 0.19-0.95), smokers (OR = 0.35; 95% CI = 0.14-0.86), and African Americans (OR = 0.23; 95% CI = 0.09-0.58) were less likely to have ≥5% weight gain than their respective counterparts. Among DCIS patients, older patients (OR = 0.94; 95% CI = 0.89-0.99) were less likely to have ≥5% weight gain. Among controls, smokers were more likely to have ≥5% weight gain (OR = 3.03; 95% CI = 1.49-6.17). Conclusions: EIBC patients were more likely than DCIS patients and controls to experience ≥5% weight gain over follow-up. Studies are necessary to elucidate mechanisms of weight gain in early-stage breast cancer survivors.
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Affiliation(s)
| | - Xiaoyan Wang
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Pérez
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mario Schootman
- Department of Clinical Analytics and Insight, Center for Clinical Excellence, SSM Health, St. Louis, Missouri
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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GÜZELÖZ Z, ARICAN ALICIKUŞ Z, AKTÜRK N, GÜRAY M, SEVİNÇ Aİ, BALCI P, BİLKAY GÖRKEN İ. Treatment results in patients with ductal carcinoma in situ treated with adjuvant radiotherapy. Turk J Med Sci 2019; 49:1151-1156. [PMID: 31382732 PMCID: PMC7018213 DOI: 10.3906/sag-1810-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/aim The aim of this study was to evaluate the treatment results of patients undergoing adjuvant radiotherapy (ART) after breast surgery with the diagnosis of ductal carcinoma in situ (DCIS). Materials and methods A total of 61 women who had undergone radiotherapy following extensive surgical excision were enrolled. All patients underwent 50 Gy ART. Survival analysis was performed using Kaplan–Meier analysis and SPSS 20.0. Results The median age was 52 years (range: 28–86). The median follow-up period after RT was 92 months (range: 23–237). The median overall survival and distant and regional recurrence-free and disease-specific survival was 96 months (range: 26–240), while disease-free and local recurrence-free survival was 96 months (range: 22–240). While the 15-year and 20-year overall survival rates were 87% and 87%, respectively, the recurrence-free survival rates were 98% and 98%, respectively; the rates of disease-specific survival were 100% and 100%, respectively. Conclusion The results of this study with a long follow-up period have shown that ART in DCIS is an effective treatment method to provide local disease control. However, further large studies are needed to identify the prognostic factors.
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Affiliation(s)
- Zeliha GÜZELÖZ
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Tepecik Regional Training and Research Hospital, University of Health Sciences, İzmirTurkey
| | - Zümre ARICAN ALICIKUŞ
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Nesrin AKTÜRK
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Merih GÜRAY
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Ali İbrahim SEVİNÇ
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - Pınar BALCI
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
| | - İlknur BİLKAY GÖRKEN
- Dokuz Eylül University Medical School/Dokuz Eylül University Breast Tumor Group, İzmirTurkey
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylül University, İzmirTurkey
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22
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Klimov S, Miligy IM, Gertych A, Jiang Y, Toss MS, Rida P, Ellis IO, Green A, Krishnamurti U, Rakha EA, Aneja R. A whole slide image-based machine learning approach to predict ductal carcinoma in situ (DCIS) recurrence risk. Breast Cancer Res 2019; 21:83. [PMID: 31358020 PMCID: PMC6664779 DOI: 10.1186/s13058-019-1165-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background Breast ductal carcinoma in situ (DCIS) represent approximately 20% of screen-detected breast cancers. The overall risk for DCIS patients treated with breast-conserving surgery stems almost exclusively from local recurrence. Although a mastectomy or adjuvant radiation can reduce recurrence risk, there are significant concerns regarding patient over-/under-treatment. Current clinicopathological markers are insufficient to accurately assess the recurrence risk. To address this issue, we developed a novel machine learning (ML) pipeline to predict risk of ipsilateral recurrence using digitized whole slide images (WSI) and clinicopathologic long-term outcome data from a retrospectively collected cohort of DCIS patients (n = 344) treated with lumpectomy at Nottingham University Hospital, UK. Methods The cohort was split case-wise into training (n = 159, 31 with 10-year recurrence) and validation (n = 185, 26 with 10-year recurrence) sets. The sections from primary tumors were stained with H&E, then digitized and analyzed by the pipeline. In the first step, a classifier trained manually by pathologists was applied to digital slides to annotate the areas of stroma, normal/benign ducts, cancer ducts, dense lymphocyte region, and blood vessels. In the second step, a recurrence risk classifier was trained on eight select architectural and spatial organization tissue features from the annotated areas to predict recurrence risk. Results The recurrence classifier significantly predicted the 10-year recurrence risk in the training [hazard ratio (HR) = 11.6; 95% confidence interval (CI) 5.3–25.3, accuracy (Acc) = 0.87, sensitivity (Sn) = 0.71, and specificity (Sp) = 0.91] and independent validation [HR = 6.39 (95% CI 3.0–13.8), p < 0.0001;Acc = 0.85, Sn = 0.5, Sp = 0.91] cohorts. Despite the limitations of our cohorts, and in some cases inferior sensitivity performance, our tool showed superior accuracy, specificity, positive predictive value, concordance, and hazard ratios relative to tested clinicopathological variables in predicting recurrences (p < 0.0001). Furthermore, it significantly identified patients that might benefit from additional therapy (validation cohort p = 0.0006). Conclusions Our machine learning-based model fills an unmet clinical need for accurately predicting the recurrence risk for lumpectomy-treated DCIS patients. Electronic supplementary material The online version of this article (10.1186/s13058-019-1165-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sergey Klimov
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.,Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, USA
| | - Islam M Miligy
- Department of Cellular Pathology, University of Nottingham, Nottingham, UK
| | - Arkadiusz Gertych
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yi Jiang
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, USA
| | - Michael S Toss
- Department of Cellular Pathology, University of Nottingham, Nottingham, UK
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ian O Ellis
- Department of Cellular Pathology, University of Nottingham, Nottingham, UK
| | - Andrew Green
- Department of Cellular Pathology, University of Nottingham, Nottingham, UK
| | | | - Emad A Rakha
- Department of Cellular Pathology, University of Nottingham, Nottingham, UK. .,Division of Cancer and Stem Cells School of Medicine, University of Nottingham City Hospital Campus, Nottingham, NG5 1PB, UK.
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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Abstract
Supplemental Digital Content is available in the text Objective: To assess cause-specific mortality in women treated for ductal carcinoma in situ (DCIS). Background: From screening and treatment perspective, it is relevant to weigh the low breast cancer mortality after DCIS against mortality from other causes and expected mortality in the general population. Methods: We conducted a population-based cohort study comprising 9799 Dutch women treated for primary DCIS between 1989 and 2004 and estimated standardized mortality ratios (SMRs). Results: After a median follow up of 9.8 years, 1429 patients had died of whom 284 caused by breast cancer (2.9% of total cohort). DCIS patients <50 years experienced higher mortality compared with women in the general population (SMR 1.7; 95% confidence interval, CI: 1.4–2.0), whereas patients >50 had significantly lower mortality (SMR 0.9; 95% CI: 0.8–0.9). Overall, the risk of dying from general diseases and cancer other than breast cancer was lower than in the general population, whereas breast cancer mortality was increased. The SMR for breast cancer decreased from 7.5 (95% CI: 5.9–9.3) to 2.8 (95% CI: 2.4–3.2) for women aged <50 and >50 years, respectively. The cumulative breast cancer mortality 10 years after DCIS was 2.3% for women <50 years and 1.4% for women >50 years treated for DCIS between 1999 and 2004. Conclusions: DCIS patients >50 years had lower risk of dying from all causes combined compared with the general female population, which may reflect differences in health behavior. Women with DCIS had higher risk of dying from breast cancer than the general population, but absolute 10-year risks were low.
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Rakovitch E, Nofech-Mozes S, Hanna W, Sutradhar R, Baehner FL, Miller DP, Fong C, Gu S, Tuck A, Sengupta S, Elavathil L, Jani PA, Bonin M, Chang MC, Slodkowska E, Anderson JM, Cherbavaz DB, Shak S, Paszat L. Multigene Expression Assay and Benefit of Radiotherapy After Breast Conservation in Ductal Carcinoma in Situ. J Natl Cancer Inst 2019; 109:2740717. [PMID: 30053207 DOI: 10.1093/jnci/djw256] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background Most women with ductal carcinoma in situ (DCIS) will receive breast-conserving surgery (BCS) and radiation (RT). RT can be omitted for women at low risk of local recurrence (LR). The Oncotype DX DCIS score (DS) predicts LR risk after BCS alone. This study assesses the impact of RT and DS on LR risk. Methods Population-based cohort analysis of individuals with DCIS treated by BCS ± RT from 1994-2003. Treatment and outcomes were determined by linkage and chart review. We used a propensity score-adjusted multivariable model to examine associations between DS and LR and evaluate the impact of RT. All statistical tests were two-sided. Results The cohort includes 571 individuals treated by BCS alone, 689 cases treated with BCS + RT. Median follow-up was 9.4 years. On multivariable analysis, factors associated with LR include RT, age at diagnosis, tumor size, and multifocality. Adjusting for these factors, the DS risk group was statistically significantly associated with LR risk (hazard ratio high/intermediate = 1.75, 95% confidence interval = 1.28 to 2.41, P < .001). Women with a low-risk DS treated by BCS alone had an LR risk of 10.6% at 10 years and a small benefit from RT, while those with a high DS had a higher risk of LR (25.4%) after BCS alone and greater benefit from RT. A subgroup of patients with favorable clinicopathological features had a high-risk DS; these patients had a higher than expected risk of LR after BCS alone and a greater benefit with RT. Conclusions The DS molecular assay improves risk stratification and estimates of RT benefit in individuals with DCIS treated with breast-conserving therapy.
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Affiliation(s)
- Eileen Rakovitch
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Sharon Nofech-Mozes
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Wedad Hanna
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Rinku Sutradhar
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Frederick L Baehner
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Dave P Miller
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Cindy Fong
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Sumei Gu
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Alan Tuck
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Sandip Sengupta
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Leela Elavathil
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Prashant A Jani
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Michel Bonin
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Martin C Chang
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Elzbieta Slodkowska
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Joseph M Anderson
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Diana B Cherbavaz
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Steven Shak
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
| | - Lawrence Paszat
- Affiliations of authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada (ER, SNM, WH, ES, LP); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (ER, RS, SG, LP); University of Toronto, Toronto, ON, Canada (ER, SNM, WH, MCC, LP); Genomic Health, Inc., Redwood City, CA (FLB, DPM, JMA, DBC, SS); University of California, San Francisco (UCSF), San Francisco, CA (FLB); London Health Sciences Centre, London, ON, Canada (AT); Kingston General Hospital, Kingston, ON, Canada (SS); Henderson General Hospital, Hamilton, ON, Canada (LE); Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada (PAJ); Northern Ontario School of Medicine, Thunder Bay, ON, Canada (PAJ); Health Sciences North Sudbury, Sudbury, ON, Canada (MB); Mount Sinai Hospital, Toronto, ON, Canada (MCC)
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Choi SH, Choi JS, Han BK, Ko EY, Ko ES, Park KW. Long-term Surveillance of Ductal Carcinoma in Situ Detected with Screening Mammography versus US: Factors Associated with Second Breast Cancer. Radiology 2019; 292:37-48. [PMID: 31038406 DOI: 10.1148/radiol.2019181844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The relationship between method of breast cancer screening (mammography or US) and survival outcome in patients with screening-detected ductal carcinoma in situ (DCIS) has not been determined. Purpose To investigate whether different methods of breast cancer screening are associated with different survival outcomes in patients with screening-detected DCIS and to evaluate clinical-pathologic and imaging factors associated with second breast cancer. Materials and Methods We retrospectively identified women who underwent surgery to treat DCIS initially detected with screening mammography or US between July 2004 and December 2011 in a single institution. Overall survival (OS) and disease-free survival (DFS) were assessed. Factors associated with second breast cancer (invasive carcinoma or DCIS) were found with multivariable Cox proportional hazards regression analysis. Subgroups were analyzed according to screening method. Results A total of 814 women (median age, 47 years; age range, 25-81 years) were included; 627 underwent treatment for screening mammography-detected DCIS (mammography-detected group), and 187 underwent treatment for screening US-detected DCIS (US-detected group). During follow-up (median, 7 years; interquartile range, 5-8 years), 26 ipsilateral and 26 contralateral second breast cancers (6.4%, 52 of 814) were found, with 44 in the mammography-detected group and eight in the US-detected group. The overall 5-year OS and DFS rates were 100% and 95.3%, respectively. DFS rates did not differ according to screening method (P = .21, 5-year DFS rates were 94.9% in the mammography-detected group and 96.5% in the US-detected group). In the mammography-detected group, higher nuclear grade (intermediate grade: hazard ratio [HR], 5.7; 95% confidence interval [CI]: 1.3, 24.3; P = 0.02) (high grade: HR, 8.0; 95% CI: 1.9, 34.2; P = .01) and dense breast (HR, 3.5; 95% CI: 1.1, 11.4; P = 0.04) were associated with second breast cancer. In the US-detected group, human epidermal growth factor receptor 2 positivity was associated with second breast cancer (HR, 9.2; 95% CI: 2.2, 38.5; P = .002). Conclusion Disease-free survival of patients who underwent treatment for screening-detected ductal carcinoma in situ (DCIS) did not differ according to screening detection method. In patients with screening mammography-detected DCIS, higher nuclear grade and dense breast were associated with second breast cancer, and in patients with screening US-detected DCIS, human epidermal growth factor 2 positivity was associated with second breast cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Fowler in this issue.
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Affiliation(s)
- Seung Hee Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ji Soo Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Boo-Kyung Han
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Eun Young Ko
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Eun Sook Ko
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ko Woon Park
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Paszat L, Sutradhar R, Zhou L, Nofech-Mozes S, Rakovitch E. Including the Ductal Carcinoma-In-Situ (DCIS) Score in the Development of a Multivariable Prediction Model for Recurrence After Excision of DCIS. Clin Breast Cancer 2019; 19:35-46. [DOI: 10.1016/j.clbc.2018.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 10/28/2022]
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Si J, Yang B, Guo R, Huang N, Quan C, Ma L, Xiu B, Cao Y, Tang Y, Shen L, Chen J, Wu J. Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy. Cancer Biol Med 2019; 16:312-318. [PMID: 31516751 PMCID: PMC6713631 DOI: 10.20892/j.issn.2095-3941.2018.0159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Patients preoperatively diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) exhibit a significant risk for upstaging on final pathology, which leads to major concerns of whether axillary staging is required at the primary operation. The present study aimed to identify clinicopathological factors associated with upstaging in patients preoperatively diagnosed with DCIS by CNB. Methods The present study enrolled 604 patients (cN0M0) with a preoperative diagnosis of pure DCIS by CNB, who underwent axillary staging between August 2006 and December 2015, at Fudan University Shanghai Cancer Center (Shanghai, China). Predictive factors of upstaging were analyzed retrospectively. Results Of the 604 patients, 20.03% (n = 121) and 31.95% (n = 193) were upstaged to DCIS with microinvasion (DCISM) and invasive breast cancer (IBC) on final pathology, respectively. Larger tumor size on ultrasonography (> 2 cm) was independently associated with upstaging [odds ratio (OR) 1.558,P = 0.014]. Additionally, patients in lower breast imaging reporting and data system (BI-RADS) categories were less likely to be upstaged (4B vs. 5: OR 0.435, P = 0.002; 4C vs. 5: OR 0.502, P = 0.001). Overall, axillary metastasis occurred in 6.79% (n = 41) of patients. Among patients with axillary metastasis, 1.38% (4/290), 3.31% (4/121) and 17.10% (33/193) were in the DCIS, DCISM, and IBC groups, respectively. Conclusions For patients initially diagnosed with DCIS by CNB, larger tumor size on ultrasonography (> 2 cm) and higher BI-RADS category were independent predictive factors of upstaging on final pathology. Thus, axillary staging in patients with smaller tumor sizes and lower BI-RADS category may be omitted, with little downstream risk for upstaging.
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Affiliation(s)
- Jing Si
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Benlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Naisi Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Chenlian Quan
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Linxiaoxi Ma
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Yun Cao
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Yue Tang
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Linxiao Shen
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Jiajian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai 200032, China
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Rojas KE, Fortes TA, Borgen PI. Leveraging the variable natural history of ductal carcinoma in situ (DCIS) to select optimal therapy. Breast Cancer Res Treat 2018; 174:307-313. [PMID: 30536119 DOI: 10.1007/s10549-018-05080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Ductal carcinoma in situ (DCIS) is a non-obligate precursor to invasive ductal carcinoma. The authors sought to discuss the evidence suggesting that not all DCIS will progress to invasive disease if left untreated. RESULTS Four lines of evidence align to suggest that not all of this in-situ disease progresses to invasive cancer: its prevalence on screening mammography, studies of missed diagnoses, incidental findings in autopsy specimens, and large retrospective reviews of those treated with excision alone. CONCLUSION A clearer understanding of the variable history of DCIS coupled with advances in genomic profiling of the disease holds the promise of reducing widespread over-treatment of this non-invasive cancer. Additionally, identification of higher risk of recurrence subsets may select patients for whom more aggressive treatment may be appropriate.
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Affiliation(s)
- Kristin E Rojas
- Department of Surgery, Brooklyn Breast Cancer Program of Maimonides Medical Center, 745 64th Street, Brooklyn, NY, 11220, USA.
| | - Thais A Fortes
- Department of Surgery, Brooklyn Breast Cancer Program of Maimonides Medical Center, 745 64th Street, Brooklyn, NY, 11220, USA
| | - Patrick I Borgen
- Department of Surgery, Brooklyn Breast Cancer Program of Maimonides Medical Center, 745 64th Street, Brooklyn, NY, 11220, USA
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Roca-Barceló A, Viñas G, Pla H, Carbó A, Comas R, Izquierdo Á, Pinheiro PS, Vilardell L, Solans M, Marcos-Gragera R. Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013). Clin Transl Oncol 2018; 21:891-899. [PMID: 30536209 DOI: 10.1007/s12094-018-1994-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.
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Affiliation(s)
- A Roca-Barceló
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain. .,UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - G Viñas
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - H Pla
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - A Carbó
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - R Comas
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Oncology Data Science (ODysSey) Group, Vall d' Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Á Izquierdo
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - P S Pinheiro
- Department of Epidemiology, University of Miami Miller School of Medicine, Slvester Comprehensive Cancer Center, Miami, FL, USA
| | - L Vilardell
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain
| | - M Solans
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, 17003, Girona, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
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Doke K, Butler S, Mitchell MP. Current Therapeutic Approaches to DCIS. J Mammary Gland Biol Neoplasia 2018; 23:279-291. [PMID: 30267199 DOI: 10.1007/s10911-018-9415-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/18/2018] [Indexed: 12/21/2022] Open
Abstract
Treatment for ductal carcinoma in-situ (DCIS) has historically been extrapolated from studies of invasive breast cancer. Accepted local therapy approaches range from small local excisions, with or without radiation, to bilateral mastectomies. Systemic treatment with endocrine therapy is often recommended for hormone positive patients. With improvements in imaging, pathologic review, and treatment techniques in the modern era, combined with new information regarding tumor biology, the management of DCIS is rapidly evolving. A multidisciplinary approach to treatment is now more important than ever, with a shift towards de-escalating therapy to reduce treatment related toxicity. This review focuses on nuances of clinical management of DCIS in the modern era, highlighting key differences between DCIS as compared to invasive breast cancer. The American Cancer Society (ACS) currently recommends beginning screening with annual mammograms for women age 45, with the option to start at age 40. As treatment of DCIS has not been shown to impact survival, the USPSTF has more conservative screening recommendations of biennial mammograms from age 50-74. Unlike invasive breast cancer, DCIS is almost exclusively diagnosed by mammographic detection, and lymph node evaluation is not recommended. Pathologic review of biopsy specimens should follow the guidelines of the College of American Pathologists. Surgical management options include breast conservation, mastectomy, or possibly nipple sparing mastectomy, with upfront sentinel lymph node evaluation in the case of mastectomy. Radiation therapy is generally recommended as a component of breast conserving therapy for patients with DCIS, though in some low risk patients, there is trial data to suggest that adjuvant radiation may be omitted. Techniques for minimizing radiation toxicity should always be emphasized. Endocrine therapy is offered to women with hormone positive DCIS who have undergone lumpectomy for risk reduction, and has the benefit of decreasing incidence of events in both the ipsilateral and contralateral breast. More recent studies have explored use of targeted treatments such as trastuzumab in DCIS for HER2 overexpression. Future directions include tailoring therapy based on patient characteristics and tumor biology. With so many different options for treatment, it is also critical to engage in a discussion with the patient to arrive at a treatment decision that balances patient preferences for disease control versus treatment toxicity, financial toxicity, cosmesis, and quality of life.
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Affiliation(s)
- Kaleigh Doke
- Department of Radiation Oncology, The Kansas University Medical Center, 3901 Rainbow Blvd., Mailstop 4033, Kansas City, KS, 66160, USA
| | - Shirley Butler
- Department of Radiation Oncology, The Kansas University Medical Center, 3901 Rainbow Blvd., Mailstop 4033, Kansas City, KS, 66160, USA
| | - Melissa P Mitchell
- Department of Radiation Oncology, The Kansas University Medical Center, 3901 Rainbow Blvd., Mailstop 4033, Kansas City, KS, 66160, USA.
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Zhang S, Liu Y, Yun S, Lian M, Komaie G, Colditz GA. Impacts of Neighborhood Characteristics on Treatment and Outcomes in Women with Ductal Carcinoma In Situ of the Breast. Cancer Epidemiol Biomarkers Prev 2018; 27:1298-1306. [PMID: 30108100 DOI: 10.1158/1055-9965.epi-17-1102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/29/2018] [Accepted: 08/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background: This study examines associations of neighborhood characteristics with treatment and outcomes of ductal carcinoma in situ (DCIS) of the breast.Methods: From the Missouri Cancer Registry, we identified 9,195 women with DCIS diagnosed between 1996 and 2011. A composite index using U.S. Census data and American Community Survey data was developed to assess census tract-level socioeconomic deprivation, and rural-urban commuting area codes were used to define rural census tracts. ORs and 95% confidence intervals (CIs) of the treatment were estimated using logistic regression. Hazard ratios (HRs) of DCIS outcomes were estimated using Cox proportional hazards regression.Results: Women in the most socioeconomically deprived census tracts were more likely than those in the least deprived to have mastectomy (OR = 1.44; 95% CI, 1.25-1.66; P trend < 0.0001), no surgery (OR = 1.54; 95% CI, 1.02-2.30; P trend = 0.04), no radiotherapy post-breast conserving surgery (OR = 1.90; 95% CI, 1.56-2.31; P trend<0.0001), delayed radiotherapy (OR = 1.26; 95% CI, 1.01-1.57; P trend = 0.02), and ipsilateral breast tumors (HR = 1.59; 95% CI, 1.07-2.38; P trend = 0.03). There was no significant difference in risk of contralateral breast tumors. Compared with urban women, rural women had significantly higher odds of underutilization of radiotherapy (OR = 1.29; 95% CI, 1.08-1.53). Rural locations were not associated with risk of ipsilateral or contralateral breast tumors.Conclusions: Neighborhood socioeconomic deprivation was associated with higher risks of suboptimal treatment and ipsilateral breast tumors. While DCIS treatment significantly varied by rural/urban locations, we did not observe any statistically significant rural-urban differences in risks of second breast tumors.Impact: Neighborhood attributes may affect treatment and outcomes of patients with DCIS. Cancer Epidemiol Biomarkers Prev; 27(11); 1298-306. ©2018 AACR.
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Affiliation(s)
- Shiyang Zhang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
| | - Shumei Yun
- Missouri Department of Mental Health, Jefferson City, Missouri
| | - Min Lian
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri.,Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Goldie Komaie
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. .,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
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Breast cancer-related deaths according to grade in ductal carcinoma in situ: A Dutch population-based study on patients diagnosed between 1999 and 2012. Eur J Cancer 2018; 101:134-142. [PMID: 30059817 DOI: 10.1016/j.ejca.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of ductal carcinoma in situ (DCIS) has drastically increased over the past decades. Because DCIS is resected after diagnosis similar to invasive breast cancer, the natural cause and behaviour of DCIS is not well known. We aimed to determine breast cancer-specific survival (BCSS) and overall survival (OS) according to grade in DCIS patients after surgical treatment in the Netherlands. PATIENTS AND METHODS All DCIS patients diagnosed between 1999 and 2012 were selected from the Netherlands Cancer Registry. The cause of death was obtained from 'Statistics Netherlands'. BCSS and OS were estimated using multivariable Cox regression in the entire cohort and stratified for grades. RESULTS In total, 12,256 patients were included, of whom 1509 (12.3%) presented with grade I, 3675 (30.0%) with grade II, 6064 (49.5%) with grade III and 1008 (8.2%) with an unknown grade. During a median follow-up of 7.8 years, 1138 (9.3%) deaths were observed, and 179 (1.5%) were breast cancer-related. Of these, 10 patients had grade I; 46 grade II; 95 grade III and 28 an unknown grade. After adjustment for confounding, grade II and III were related to worse BCSS than grade I with hazard ratios of 1.92 (95% confidence interval [CI]: 0.97-3.81) and 2.14 (95% CI: 1.11-4.12), respectively. No association between grades and OS was observed. CONCLUSION BCSS and OS in DCIS patients were excellent. Because superior rates were observed for low-grade DCIS, it seems justified to investigate whether active surveillance may be a balanced alternative for conventional surgical treatment.
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Risk of ischemic heart disease after radiotherapy for ductal carcinoma in situ. Breast Cancer Res Treat 2018; 171:95-101. [PMID: 29730730 DOI: 10.1007/s10549-018-4803-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The use of adjuvant radiotherapy (RT) in the management of ductal carcinoma in situ (DCIS) is increasing. Left-sided breast irradiation may involve exposure of the heart to ionising radiation, increasing the risk of ischemic heart disease (IHD). We examined the incidence of IHD in a population-based cohort of women with DCIS. METHODS The Breast Cancer DataBase Sweden (BCBase) cohort includes women registered with invasive and in situ breast cancers 1992-2012 and age-matched women without a history of breast cancer. In this analysis, 6270 women with DCIS and a comparison cohort of 31,257 women were included. Through linkage with population-based registers, data on comorbidity, socioeconomic status and incidence of IHD was obtained. Hazard ratios (HR) for IHD with 95% confidence intervals (CI) were analysed. RESULTS Median follow-up time was 8.8 years. The risk of IHD was not increased for women with DCIS versus women in the comparison cohort (HR 0.93; 95% CI 0.82-1.06), after treatment with radiotherapy versus surgery alone (HR 0.77; 95% CI 0.60-0.98) or when analysing RT by laterality (HR 0.85; 95% CI 0.53-1.37 for left-sided versus right-sided RT). CONCLUSIONS The risk of IHD was lower for women with DCIS allocated to RT compared to non-irradiated women and to the comparison cohort, probably due to patient selection. Comparison of RT by laterality did not show any over-risk for irradiation of the left breast.
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Role of MR Imaging for the Locoregional Staging of Breast Cancer. Magn Reson Imaging Clin N Am 2018; 26:191-205. [DOI: 10.1016/j.mric.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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D'eredità G, Giardina C, Napoli A, Ingravallo G, Leopoldo Troilo V, Fischetti F, Berardi T. Sentinel Lymph Node Biopsy in Patients with Pure and High-Risk Ductal Carcinoma in Situ of the Breast. TUMORI JOURNAL 2018; 95:706-11. [DOI: 10.1177/030089160909500612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aims and Background The role of sentinel lymph node biopsy in patients initially diagnosed with ductal carcinoma in situ resides in determining the predictors of invasive disease. The aim of the present study was to examine the incidence of sentinel lymph node metastases in a selected group of patients, with characteristics of high-risk ductal carcinoma in situ, in order to determine the clinical usefulness of sentinel lymph node biopsy. Methods A total of 90 patients with a biopsy diagnosis of ductal carcinoma in situ were treated. Fifty-two patients with high-risk ductal carcinoma in situ had sentinel lymph node biopsy. The following characteristics of the primary tumor were considered as indicative of a risk of invasive disease: presence of palpable mass, mammographic mass, multicentric disease that required mastectomy, and histologically high nuclear grade or non-high nuclear grade with necrosis. Subdermal injections of 99mTc-labeled human albumin and subareolar injection ofblue dye were used for sentinel lymph node identification. All sentinel nodes were sectioned serially and stained with hematoxylin and eosin. Immunohistochemical analysis was performed using a cytokeratin monoclonal antibody. Results A positive sentinel lymph node was found in only one patient (1.9%). The patient had a double lesion, and core-needle biopsy showed an atypical ductal hyperplasia and a intermediate degree of ductal carcinoma in situ. At pathologic review of the specimen, no invasive aspect was detected. Conclusions The results of our study indicate that sentinel lymph node metastasis in pure ductal carcinoma in situ is extremely uncommon. We therefore suggest that sentinel lymph node biopsy might be indicated for patients with ductal carcinoma in situ detected as a palpable mass or as large extensive microcalcifications, as well as for patients who are undergoing mastectomy, especially with immediate reconstruction.
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Affiliation(s)
| | | | - Anna Napoli
- Department of Pathology, University of Bari, Bari, Italy
| | | | | | | | - Tommaso Berardi
- Department of Clinical Methodology and Medical-Surgical Technologies
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Huang N, Si J, Yang B, Quan C, Chen J, Wu J. Trends and clinicopathological predictors of axillary evaluation in ductal carcinoma in situ patients treated with breast-conserving therapy. Cancer Med 2018; 7:56-63. [PMID: 29271113 PMCID: PMC5774004 DOI: 10.1002/cam4.1252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to investigate the trends of axillary lymph node evaluation in ductal carcinoma in situ (DCIS) patients treated with breast-conserving therapy (BCT) and to identify the clinicopathological predictors of axillary evaluation. DCIS patients treated with BCT in 2006-2015 at our institute were retrospectively included in the analysis. Patients were categorized into three groups: sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), and non-evaluation. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted axillary evaluation. A total of 315 patients were identified, among whom 135 underwent SLNB, and 15 underwent ALND. The proportion of patients who underwent axillary evaluation increased from 33.0% in 2006-2010 to 53.8% in 2011-2015 (P < 0.001), however, no patients had lymph node metastasis based on final pathology. In multivariate analysis, high-grade tumor favored axillary evaluation (OR = 4.376, 95% CI:1.410-13.586, P = 0.011); while excision biopsy favored no axillary evaluation compared with other biopsy methods (OR = 0.418, 95% CI: 0.192-0.909, P = 0.028). Subgroup analysis of patients treated in 2011-2015 revealed that high-grade tumor (OR = 5.898, 95% CI: 1.626-21.390, P = 0.007) and palpable breast lump (OR = 2.497, 95% CI: 1.037-6.011, P = 0.041) were independent predictors of axillary lymph node evaluation. Despite the significant decrease in ALND and a concerning overuse of SLNB, we identified no axillary lymph node metastasis, which justified omitting axillary evaluation in these patients. High-grade tumor, palpable lump, and biopsy method were independent predictors of axillary evaluations. Excision biopsy of suspicious DCIS lesions may potentially preclude the invasive component of the disease and help to avoid axillary surgery.
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Affiliation(s)
- Nai‐si Huang
- Department of Breast SurgeryFudan University Shanghai Cancer CenterNo. 270, Dongan RdShanghai200032China
- Department of OncologyFudan University Shanghai Medical CollegeShanghaiChina
| | - Jing Si
- Department of Breast SurgeryFudan University Shanghai Cancer CenterNo. 270, Dongan RdShanghai200032China
- Department of OncologyFudan University Shanghai Medical CollegeShanghaiChina
| | - Ben‐long Yang
- Department of Breast SurgeryFudan University Shanghai Cancer CenterNo. 270, Dongan RdShanghai200032China
- Department of OncologyFudan University Shanghai Medical CollegeShanghaiChina
| | - Chen‐lian Quan
- Department of Breast SurgeryFudan University Shanghai Cancer CenterNo. 270, Dongan RdShanghai200032China
- Department of OncologyFudan University Shanghai Medical CollegeShanghaiChina
| | - Jia‐jian Chen
- Department of Breast SurgeryFudan University Shanghai Cancer CenterNo. 270, Dongan RdShanghai200032China
- Department of OncologyFudan University Shanghai Medical CollegeShanghaiChina
| | - Jiong Wu
- Department of Breast SurgeryFudan University Shanghai Cancer CenterNo. 270, Dongan RdShanghai200032China
- Department of OncologyFudan University Shanghai Medical CollegeShanghaiChina
- Collaborative Innovation Center for Cancer MedicineShanghaiChina
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Levinsohn E, Altman M, Chagpar AB. Article Commentary: Controversies Regarding the Diagnosis and Management of Ductal Carcinoma in Situ. Am Surg 2018. [DOI: 10.1177/000313481808400102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ductal carcinoma in situ (DCIS) is a premalignant condition, whose incidence is increasing in the current era of widespread screening mammography. While eminently treatable, there are innumerable controversies that surround this disease in terms of its diagnosis and treatment. We discuss these issues and review the data to date regarding this condition which affects roughly 20 per cent of all patients presenting with breast cancer.
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Affiliation(s)
- Erik Levinsohn
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Marcus Altman
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anees B. Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Severe depression more common in patients with ductal carcinoma in situ than early-stage invasive breast cancer patients. Breast Cancer Res Treat 2017; 167:205-213. [DOI: 10.1007/s10549-017-4495-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 11/12/2022]
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Veal CT, Hart V, Lakoski SG, Hampton JM, Gangnon RE, Newcomb PA, Higgins ST, Trentham-Dietz A, Sprague BL. Health-related behaviors and mortality outcomes in women diagnosed with ductal carcinoma in situ. J Cancer Surviv 2017; 11:320-328. [PMID: 28058695 PMCID: PMC5419859 DOI: 10.1007/s11764-016-0590-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/16/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE Women diagnosed with ductal carcinoma in situ (DCIS) of the breast are at greater risk of dying from cardiovascular disease and other causes than from breast cancer, yet associations between health-related behaviors and mortality outcomes after DCIS have not been well studied. METHODS We examined the association of body mass index, physical activity, alcohol consumption, and smoking with mortality among 1925 women with DCIS in the Wisconsin In Situ Cohort study. Behaviors were self-reported through baseline interviews and up to three follow-up questionnaires. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality after DCIS, with adjustment for patient sociodemographic, comorbidity, and treatment factors. RESULTS Over a mean of 6.7 years of follow-up, 196 deaths occurred. All-cause mortality was elevated among women who were current smokers 1 year prior to diagnosis (HR = 2.17 [95% CI 1.48, 3.18] vs. never smokers) and reduced among women with greater physical activity levels prior to diagnosis (HR = 0.55 [95% CI: 0.35, 0.87] for ≥5 h per week vs. no activity). Moderate levels of post-diagnosis physical activity were associated with reduced all-cause mortality (HR = 0.31 [95% CI 0.14, 0.68] for 2-5 h per week vs. no activity). Cancer-specific mortality was elevated among smokers and cardiovascular disease mortality decreased with increasing physical activity levels. CONCLUSIONS There are numerous associations between health-related behaviors and mortality outcomes after a DCIS diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Women diagnosed with DCIS should be aware that their health-related behaviors are associated with mortality outcomes.
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Affiliation(s)
- Christopher Thomas Veal
- Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Vicki Hart
- Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Susan G Lakoski
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Clinical Cancer Prevention & Cardiology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Polly A Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephen T Higgins
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
- Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Amy Trentham-Dietz
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, 1 South Prospect Street, Rm. 4428, Burlington, VT, 05401, USA.
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA.
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.
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Reid L. Truth or Spin? Disease Definition in Cancer Screening. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 42:385-404. [DOI: 10.1093/jmp/jhx006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Wai ES, Lesperance M, Lu L, Alexander CS, Truong PT. Effect of Referral Patterns and Treatment Type on Oncologic Outcomes for Women with Ductal Carcinoma In Situ. Cureus 2017; 9:e1128. [PMID: 28465875 PMCID: PMC5409819 DOI: 10.7759/cureus.1128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective Management of ductal carcinoma in situ (DCIS) remains controversial. This study examined long-term outcomes in a population-based cohort of patients with pure DCIS treated with breast-conserving surgery (BCS) alone, BCS + radiotherapy (RT), and mastectomy. Outcomes were compared between patients referred versus not referred for oncologic assessment after definitive surgery. Materials and methods Subjects were 2575 women diagnosed between 1985 and 1999. Data from several electronic databases were linked and analyzed. Outcomes were invasive local recurrence-free survival (ILRFS), mastectomy-free survival (MFS), breast cancer-specific survival (BCSS), and overall survival (OS). Results Median follow-up time was 9.8 years. Overall, 56% (n = 1448) of subjects were referred to a cancer centre. Factors associated with non-referral were older age, comorbidities, and travel distance. Ten-year MFS, BCSS, and OS were higher among referred patients (all p ≤ 0.001). In cohorts treated with BCS alone (n = 1314) vs. BCS + RT (n = 510) vs. mastectomy (n = 751), 10-year ILRFS were 93.7% vs. 96.6% vs. 97.7%, (p < 0.001) and BCSS were 97.6% vs. 99.8% vs. 98.6%, (p = 0.01). Corresponding rates of ipsilateral invasive breast relapse at 10 years were 6.3% after BCS alone, 3.4% after BCS + RT, and 2.3% after mastectomy (p < 0.001). On multivariable analysis, factors associated with improved ILRFS were older age at diagnosis, low comorbidity score, absence of comedo histology, mastectomy, and post-BCS RT. Conclusion Patients with DCIS referred for oncologic assessment were more likely to undergo post-BCS RT, resulting in lower mastectomy and higher survival rates compared to non-referred patients. Patients with significant comorbidities were less likely to be referred and experienced lower ILRFS and BCSS. Referral for multidisciplinary oncologic assessment after surgery is warranted to individualize management and optimize outcomes for patients with DCIS.
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Affiliation(s)
- Elaine S Wai
- Radiation Oncology, University of British Columbia, BC Cancer Agency
| | | | | | | | - Pauline T Truong
- Radiation Oncology, University of British Columbia, BC Cancer Agency
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Elshof LE, Schaapveld M, Rutgers EJ, Schmidt MK, de Munck L, van Leeuwen FE, Wesseling J. The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study. Breast Cancer Res 2017; 19:26. [PMID: 28274272 PMCID: PMC5343406 DOI: 10.1186/s13058-017-0819-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/16/2017] [Indexed: 12/23/2022] Open
Abstract
Background Population screening with mammography has resulted in increased detection of ductal carcinoma in situ (DCIS). The aim of this population-based cohort study was to assess whether the method of detection should be considered when determining prognosis and treatment in women with DCIS. Methods This study includes 7042 women aged 49–75 years, who were surgically treated for primary DCIS between 1989 and 2004 in the Netherlands. We calculated cumulative incidences of ipsilateral and contralateral invasive breast cancer and all-cause mortality among women with screen-detected, interval, or non-screening-related DCIS, and assessed the association between method of detection and these outcomes, using multivariable Cox regression analyses. Results Compared with non-screening-related DCIS, women with screen-detected DCIS had a lower risk of developing ipsilateral invasive breast cancer (hazard ratio (HR) = 0.75, 95% CI = 0.59–0.96), but a similar risk of contralateral invasive breast cancer (HR = 0.86, 95% CI = 0.67–1.10). The absolute difference in risk of ipsilateral invasive breast cancer was 1% at 15 years. Screen detection was associated with lower all-cause mortality (HR = 0.85, 95% CI = 0.73–0.98); when we additionally accounted for the occurrence of invasive breast cancer the magnitude of this effect remained similar (HR = 0.86, 95% CI = 0.75–1.00). Conclusions Screen detection was associated with lower risk of ipsilateral invasive breast cancer and all-cause mortality. However, the absolute difference in risk of ipsilateral invasive breast cancer was very low and the lower all-cause mortality associated with screen-detected and interval DCIS might be explained by a healthy-user effect. Therefore, our findings do not justify different treatment strategies for women with screen-detected, interval, or non-screening-related DCIS. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0819-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lotte E Elshof
- Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Division of Psychosocial research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Michael Schaapveld
- Division of Psychosocial research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Emiel J Rutgers
- Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Division of Psychosocial research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. .,Department of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
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The Demographic Features, Clinicopathological Characteristics and Cancer-specific Outcomes for Patients with Microinvasive Breast Cancer: A SEER Database Analysis. Sci Rep 2017; 7:42045. [PMID: 28165014 PMCID: PMC5292735 DOI: 10.1038/srep42045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/15/2016] [Indexed: 11/08/2022] Open
Abstract
To investigate the clinicopathological characteristics and survival outcomes of microinvasive breast cancer, we conducted an observational study of female diagnosed with DCIS or DCIS with microinvasion (DCISM) from 1990 to 2012 using the Surveillance, Epidemiology, and End Results (SEER) database. There were 87695 DCIS and 8863 DCISM identified. In DCISM group, patients appeared to be younger and more black patients were identified in comparison with DCIS group. Furthermore, DCISM was associated with more aggressive tumor characteristics like higher rates of oestrogen receptor (ER) and progesterone receptor (PR) negativity, HER2 positivity, and lymph node metastasis. With a median follow-up of 91 months, patients with DCISM had worse cancer-specific survival (CSS) (hazard ratio [HR], 2.475; P < 0.001) and overall survival (OS) (HR, 1.263; P < 0.001). In the multivariable analysis, microinvasion was an independent prognostic factor for worse CSS (HR, 1.919; P < 0.001) and OS (HR, 1.184; P < 0.001). The 10-year cancer-specific mortality rate was 1.49% in DCIS and 4.08% in DCISM (HR, 2.771; P < 0.001). The 20-year cancer-specific mortality rate was 4.00% in DCIS and 9.65% in DCISM (HR, 2.482; P < 0.001). Deepening understanding of the nature of microinvasive breast cancer will be valuable for clinical treatment recommendations.
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Groen EJ, Elshof LE, Visser LL, Rutgers EJT, Winter-Warnars HA, Lips EH, Wesseling J. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast 2017; 31:274-283. [DOI: 10.1016/j.breast.2016.09.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/19/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022] Open
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Madubata CC, Liu Y, Goodman MS, Yun S, Yu J, Lian M, Colditz GA. Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race. Breast Cancer Res Treat 2016; 160:563-572. [PMID: 27771840 DOI: 10.1007/s10549-016-4030-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS). PATIENTS AND METHODS The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race. RESULTS There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95 % CI 0.99-1.35) or endocrine therapy (OR 1.19; 95 % CI 0.94-1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95 % CI 0.92-1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95 % CI 1.55-2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95 % CI 1.15-2.50) and a comparable risk of CBTs (HR 1.19; 95 % CI 0.84-1.68), which were independent of pathological features and treatment. CONCLUSION Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.
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MESH Headings
- Adenocarcinoma in Situ/diagnosis
- Adenocarcinoma in Situ/epidemiology
- Adenocarcinoma in Situ/mortality
- Adenocarcinoma in Situ/therapy
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/mortality
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/therapy
- Combined Modality Therapy
- Ethnicity
- Female
- Follow-Up Studies
- Healthcare Disparities
- Humans
- Middle Aged
- Missouri/epidemiology
- Missouri/ethnology
- Neoplasm Grading
- Neoplasm Staging
- Proportional Hazards Models
- Registries
- SEER Program
- Treatment Outcome
- Tumor Burden
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Affiliation(s)
- Chinwe C Madubata
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Shumei Yun
- Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Jennifer Yu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Min Lian
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
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Neuhouser ML, Smith AW, George SM, Gibson JT, Baumgartner KB, Baumgartner R, Duggan C, Bernstein L, McTiernan A, Ballard R. Use of complementary and alternative medicine and breast cancer survival in the Health, Eating, Activity, and Lifestyle Study. Breast Cancer Res Treat 2016; 160:539-546. [PMID: 27766453 DOI: 10.1007/s10549-016-4010-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Use of complementary and alternative medicine (CAM) is common among breast cancer patients, but less is known about whether CAM influences breast cancer survival. METHODS Health Eating, Activity, and Lifestyle (HEAL) Study participants (n = 707) were diagnosed with stage I-IIIA breast cancer. Participants completed a 30-month post-diagnosis interview including questions on CAM use (natural products such as dietary and botanical supplements, alternative health practices, and alternative medical systems), weight, physical activity, and comorbidities. Outcomes were breast cancer-specific and total mortality, which were ascertained from the Surveillance Epidemiology and End Results registries in Western Washington, Los Angeles County, and New Mexico. Cox proportional hazards regression models were fit to data to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for mortality. Models were adjusted for potential confounding by sociodemographic, health, and cancer-related factors. RESULTS Among 707 participants, 70 breast cancer-specific deaths and 149 total deaths were reported. 60.2 % of participants reported CAM use post-diagnosis. The most common CAM were natural products (51 %) including plant-based estrogenic supplements (42 %). Manipulative and body-based practices and alternative medical systems were used by 27 and 13 % of participants, respectively. No associations were observed between CAM use and breast cancer-specific (HR 1.04, 95 % CI 0.61-1.76) or total mortality (HR 0.91, 95 % CI 0.63-1.29). CONCLUSION Complementary and alternative medicine use was not associated with breast cancer-specific mortality or total mortality. Randomized controlled trials may be needed to definitively test whether there is harm or benefit from the types of CAM assessed in HEAL in relation to mortality outcomes in breast cancer survivors.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA.
| | - Ashley Wilder Smith
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Stephanie M George
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - James T Gibson
- Information Management Services, Inc., Calverton, MD, USA
| | - Kathy B Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Richard Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA
| | - Rachel Ballard
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
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Pilewskie M, Olcese C, Patil S, Van Zee KJ. Women with Low-Risk DCIS Eligible for the LORIS Trial After Complete Surgical Excision: How Low Is Their Risk After Standard Therapy? Ann Surg Oncol 2016; 23:4253-4261. [PMID: 27766556 DOI: 10.1245/s10434-016-5595-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Identifying DCIS patients at low risk for disease progression could obviate need for standard therapy. The LORIS (surgery versus active monitoring for low-risk DCIS) trial is studying the safety of monitoring low-risk DCIS, although ipsilateral breast tumor recurrence (IBTR) rates in patients meeting enrollment criteria after complete surgical excision are unknown. METHODS Women with pure DCIS treated with breast-conserving surgery (BCS) with/without radiation therapy (RT) from 1/1996-1/2011 were included from a prospectively maintained database. IBTR rates were compared between those who did and did not meet LORIS eligibility criteria (age ≥ 46 years, screen-detected calcifications, nipple discharge absence, minimal family history, non-high-grade DCIS) after complete surgical excision. RESULTS A total of 2394 women were identified; 401 met LORIS criteria. Median follow-up was 5.9 years; 431 had ≥10 years follow-up. LORIS cohort median age was 61 years (range 46-86 years); 207 (52 %) underwent RT, 79 (20 %) received endocrine therapy. Of 401 patients, 24 experienced an IBTR. Overall 10-year IBTR rates were 10.3 % (LORIS) versus 15.4 % (non-LORIS) (p = 0.08); without RT, 12.1 versus 21.4 %, respectively (p = 0.06). The 10-year invasive-IBTR rates for women meeting LORIS criteria were: 5.3 % BCS overall, 6.0 % without RT. CONCLUSIONS Women meeting LORIS criteria (after complete surgical excision) are at somewhat lower risk for IBTR. Among such women undergoing excision without RT, the 10-year invasive-IBTR rate was 6 %. Given that approximately 20 % of women with core biopsy-proven non-high-grade DCIS have invasive cancer at excision, women managed without excision would be expected to incur higher invasive cancer rates. Additional criteria are needed to identify women not requiring intervention for DCIS.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Cristina Olcese
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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He W, Sofie Lindström L, Hall P, Czene K. Cause-specific mortality in women with breast cancer in situ. Int J Cancer 2016; 140:2414-2421. [PMID: 27594272 DOI: 10.1002/ijc.30413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022]
Abstract
The long-term mortality remains unknown in women diagnosed with breast cancer in situ (BCIS). Here, we assessed the cause-specific mortality in BCIS patients. This population-based cohort study included 12,243 women diagnosed with BCIS in Sweden between 1980 and 2011. Patients were followed until death, emigration, or 31 December 2013, whichever came first. The 30-year cumulative incidence of breast cancer-specific mortality was 6.3%, which is considerably lower than 49.7% observed for other-cause mortality. Women diagnosed with BCIS were more likely to die from breast cancer (standardized mortality ratio [SMR], 3.85; 95% CI, 3.47-4.27) but less likely to die from cardiovascular disease (SMR, 0.88; 95% CI, 0.82-0.95) than women in the general population. Specifically, the SMRs for breast cancer-specific mortality decreased over time from 5.19 (95% CI, 3.95-6.81) among BCIS diagnosed during 1980-1989 to 3.03 (95% CI, 2.35-3.91) among those diagnosed during 2000-2011. Furthermore, higher risk of death from other causes was seen among those with older age at BCIS diagnosis, lower levels of education, nulliparity, higher Charlson Comorbidity Index, and being hospitalized before BCIS diagnosis; whereas, lower risk of death from breast cancer was seen among BCIS diagnosed in the later time period and those with younger age at first birth. We conclude that most women diagnosed with BCIS die from causes other than breast cancer, which highlights the need for actions not only to reduce nonbreast cancer mortality but also to identify patient where extensive curative BCIS treatment is not adding to survival.
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Affiliation(s)
- Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Yavas C, Yavas G, Toy H, Ata O. The use of concurrent hormonotherapy and radiotherapy does not deteriorate radiation-induced cardiac toxicity. Hum Exp Toxicol 2016; 36:795-801. [PMID: 27596072 DOI: 10.1177/0960327116666648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postmenopausal patients with breast cancer have two options for adjuvant endocrine therapy, tamoxifen and aromatase inhibitors (AIs) as well as radiotherapy (RT) and chemotherapy. However, there is limited data regarding the optimal sequencing of RT and tamoxifen/AIs. Thus, we aimed to evaluate the effects of tamoxifen and AIs on radiation-induced cardiotoxicity. Eighty ovariectomized rats were divided into eight groups (G). G1 was defined as a control group; G2, G3, G4, and G5 were RT, tamoxifen, anastrozle, and letrozole groups, respectively; G6, G7, and G8 were RT plus tamoxifen, anastrozle, and letrozole groups, respectively. Drugs were started 1 week before RT and continued until the animals were killed 16 weeks after RT. The heart tissues were then dissected and examined with light microscopy to determine endocardial thickness and cardiac fibrosis. The endocardial thickness scores of both RT alone and the tamoxifen groups as well as the cardiac fibrosis score of RT alone were higher than that the control group ( p < 0.05 for all). There was no difference in the endocardial thickness and cardiac fibrosis scores of the RT-only group and the RT plus hormonotherapy groups ( p > 0.05 for all). Concurrent administration of RT and hormonal therapy with either tamoxifen or AIs did not further amplify radiation-induced cardiac toxicity. This issue warrants further study.
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Affiliation(s)
- C Yavas
- 1 Department of Radiation Oncology, Selcuk University, Konya, Turkey
| | - G Yavas
- 1 Department of Radiation Oncology, Selcuk University, Konya, Turkey
| | - H Toy
- 2 Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - O Ata
- 3 Department of Medical Oncology, Selcuk University, Konya, Turkey
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Axillary evaluation and lymphedema in women with ductal carcinoma in situ. Breast Cancer Res Treat 2016; 158:373-84. [PMID: 27365080 DOI: 10.1007/s10549-016-3890-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65-90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 % of those treated with BCS and 69.4 % of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 % of women who had an axillary evaluation developed lymphedema, compared to 5.9 % of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 % CI 1.04-1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 % CI 0.40-1.74). Only 44 (0.40 %) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure.
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