Predictors of Local Recurrence in a Population-Based Cohort of Women with Ductal Carcinoma In Situ Treated with Breast Conserving Surgery Alone
To identify prognostic indicators of local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conserving surgery (BCS) alone.
A retrospective study was conducted of all women with pure DCIS, diagnosed 1985–1999, referred for tertiary oncologic opinion in British Columbia, treated with BCS without adjuvant radiotherapy. Kaplan–Meier local control (LC) and breast cancer specific survival (BCSS) estimates for the entire group were plotted. Stratified analyses identified subgroups with high Kaplan–Meier 10-year LR. Cox multivariate modeling was used to assess predictors of LR. Kaplan–Meier BCSS rates were compared between two cohorts: those who experienced LR and those who did not have LR.
A total of 460 women comprised the study cohort. Median follow-up was 9.4 years. The 15-year LC and BCSS rates were 82% and 97%, respectively. Stratified analyses of LR identified comedo histology, high nuclear grade, tumor size >4 cm or indeterminate size, and positive margins to be associated with significantly higher LR risk, with 10-year LR risks approximating 15–30%. The 10-year BCSS rates for the LR group were 94% compared with 99% for the NoLR group. On Cox regression modeling, high nuclear grade, the presence of comedocarcinoma, and positive margins were significant factors for higher risk of LR.
Women with DCIS treated with BCS alone had higher LR risk, and those with a LR were more likely to die of breast cancer. Optimal local treatment is mandatory to minimize the risk of breast cancer death for women with this curable disease.
KeywordsLocal Recurrence Breast Conserve Surgery Breast Cancer Specific Survival High Nuclear Grade British Columbia Cancer Agency
The authors would like to acknowledge funding support for this work through operating grants from the Canadian Breast Cancer Foundation, BC/Yukon Chapter, and Canadian Breast Cancer Research Alliance. The authors thank Caroline Walter for assistance with manuscript preparation.
Conflicts of Interest
The authors declare no conflicts of interest related to this work.
- 8.Olivotto I, Levine M, Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: The management of ductal carcinoma in situ (summary of the 2001 update). CMAJ. 2001;165:912–3.PubMedGoogle Scholar
- 13.Kestin LL, Goldstein NS, Martinez AA, Rebner M, Balasubramaniam M, Frazier RC, et al. Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy: patterns of failure and 10-year results. Ann Surg. 2000;231:235–45.CrossRefPubMedGoogle Scholar
- 17.British Columbia Cancer Agency. In: Rheaume D, editor. Cancer treatment policies. 5th ed. Vancouver: British Columbia Cancer Agency, 1995.Google Scholar
- 18.British Columbia Cancer Agency. Radiotherapy techniques. 1995 (in press).Google Scholar
- 19.Cancer Control Agency of British Columbia. Cancer treatment policies. 3rd ed. Vancouver: Cancer Control Agency of British Columbia, 1988.Google Scholar
- 20.Emdin SO, Granstrand B, Ringberg A, Sandelin K, Arnesson LG, Nordgren H, et al. SweDCIS: radiotherapy after sector resection for ductal carcinoma in situ of the breast: results of a randomised trial in a population offered mammography screening. Acta Oncol. 2006;45:536–43.CrossRefPubMedGoogle Scholar
- 23.Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E. Pathologic findings from the national surgical adjuvant breast project (NSABP) protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The national surgical adjuvant breast and bowel project collaborating investigators. Cancer. 1995;75:1310–9.CrossRefPubMedGoogle Scholar
- 24.Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC breast cancer cooperative group and EORTC radiotherapy group. Lancet. 2000;355:528–33.CrossRefPubMedGoogle Scholar
- 25.Adepoju LJ, Symmans WF, Babiera GV, Singletary SE, Arun B, Sneige N, et al. Impact of concurrent proliferative high-risk lesions on the risk of ipsilateral breast carcinoma recurrence and contralateral breast carcinoma development in patients with ductal carcinoma in situ treated with breast-conserving therapy. Cancer. 2006;106:42–50.CrossRefPubMedGoogle Scholar
- 27.Rodrigues N, Carter D, Dillon D, Parisot N, Choi DH, Haffty BG. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2002;54:1331–5.CrossRefPubMedGoogle Scholar
- 29.Vargas C, Kestin L, Go N, Krauss D, Chen P, Goldstein N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys. 2005;63:1514–21.CrossRefPubMedGoogle Scholar
- 32.Solin LJ, Fourquet A, Vicini FA, Haffty B, Taylor M, McCormick B, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer. 2001;91:1090–7.CrossRefPubMedGoogle Scholar
- 36.Solin LJ, Fourquet A, Vicini FA, Haffty B, Taylor M, McCormick B, et al. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status. Int J Radiat Oncol Biol Phys. 2001;50:991–1002.CrossRefPubMedGoogle Scholar