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Impact of Age on Risk of Recurrence of Ductal Carcinoma In Situ: Outcomes of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Age is a known risk factor for recurrence in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS). We explored the relationship between age, other risk factors, and recurrence.

Methods

Using a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010, the association of age and recurrence risk was analyzed using Kaplan–Meier estimates, multivariable analysis, and competing risk multivariable analysis.

Results

Overall, 2996 cases were identified. Median follow-up for those without recurrence was 75 months; 732 were followed for ≥10 years, and 363 (12 %) had recurrence [192 (53 %) DCIS, 160 (44 %) invasive, 11 (3 %) unknown]. Risk of recurrence decreased with age, even after adjustment for eight clinicopathologic variables on multivariable analysis [hazard ratios (HR), with <40 years of age as the reference: 40–49 years, 0.82 (p = 0.36), 50–59 years, 0.46 (p = 0.0005), 60–69 years, 0.50 (p = 0.003), 70–79 years, 0.56 (p = 0.02), ≥80 years, 0.21 (p = 0.0015)]. This association persisted for cohorts with and without radiation therapy. Using competing risk multivariable analysis, the effect of age on invasive recurrence was empirically stronger than for DCIS recurrence. Ten-year invasive recurrence was 16 and 6.5 % in women <40 years of age and women ≥40 years of age, respectively. Only 0.6 % of the population ultimately developed distant disease; those <40 years of age constituted 4.7 % (141/2996) of the population, but 21 % (4/19) of those developed distant disease.

Conclusions

The risk of recurrence of DCIS decreases with age. This effect is particularly strong at the extremes of age and is independent of other clinicopathologic factors. The oldest women are at low risk of recurrence, while the youngest women have a higher overall, and especially invasive, recurrence rate, although mortality remains low. These findings should be incorporated into risk/benefit discussions of treatment options.

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Acknowledgment

Funding

This study was funded in part by National Institutes of Health/National Cancer Institute Cancer Center Support Grant No. P30 CA008748.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Patricia A. Cronin MD, Cristina Olcese BS, Monica Morrow MD, FACS & Kimberly J. Van Zee MS, MD, FACS

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sujata Patil PhD

Authors
  1. Patricia A. Cronin MD
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  2. Cristina Olcese BS
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  3. Sujata Patil PhD
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  4. Monica Morrow MD, FACS
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  5. Kimberly J. Van Zee MS, MD, FACS
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Corresponding author

Correspondence to Kimberly J. Van Zee MS, MD, FACS.

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Conflicts of Interest

Patricia A. Cronin, Cristina Olcese, Sujata Patil, Monica Morrow, and Kimberly J. Van Zee have no conflicts of interest to declare.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2016_5249_MOESM1_ESM.pdf

Supplementary material 1 (PDF 417 kb). Supplementary Fig. 1 Distribution of cases of DCIS treated with breast conservation by age. The number and percentage of the population in each age group is shown

10434_2016_5249_MOESM2_ESM.pdf

Supplementary material 2 (PDF 436 kb). Supplementary Fig. 2 Number and proportion of cases of DCIS by age and treatment, for women treated 1995–2010. Numbers overlying each section of the solid bars reflect the number of cases in each age group that underwent each treatment option. Vertical axis shows proportion of each age group that underwent each treatment option

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Cronin, P.A., Olcese, C., Patil, S. et al. Impact of Age on Risk of Recurrence of Ductal Carcinoma In Situ: Outcomes of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years. Ann Surg Oncol 23, 2816–2824 (2016). https://doi.org/10.1245/s10434-016-5249-5

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  • DOI: https://doi.org/10.1245/s10434-016-5249-5

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