Annals of Surgical Oncology

, Volume 23, Issue 9, pp 2816–2824 | Cite as

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

  • Patricia A. Cronin
  • Cristina Olcese
  • Sujata Patil
  • Monica Morrow
  • Kimberly J. Van Zee
Breast Oncology

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.

Keywords

Distant Disease Compete Risk Analysis Invasive Recurrence Ipsilateral Breast Recurrence Axillary Nodal Recurrence 

Notes

Acknowledgment

Funding

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

Compliance with Ethical Standard

Conflicts of Interest

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

Supplementary material

10434_2016_5249_MOESM1_ESM.pdf (417 kb)
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 (435 kb)
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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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  1. 1.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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