Active monitoring in non-invasive breast cancer: insight gained from a large national database

Abstract

The objective was to evaluate women diagnosed with ductal carcinoma in situ (DCIS) preoperatively and elucidate factors, including time from biopsy to excision, associated with invasive disease found on final pathology (underestimation). The National Cancer Database was queried for women with preoperative DCIS receiving lumpectomy/mastectomy from 1998 to 2012 and investigated for factors associated with underestimation (invasive disease in the breast/nodes on excision). One hundred fifty-six thousand five hundred thirty-five women met inclusion criteria and 10.8% had underestimation of disease. 9.1% had invasive disease in the breast alone, 0.4% had nodal disease despite only DCIS in the breast, and 1.4% had both invasive disease in the breast and the axillary nodes. The adjusted risk of underestimation of invasive disease increased steadily with more time from biopsy to surgery (p < 0.001), as did the adjusted risk nodal disease (p < 0.001). Several presurgical findings can predict for occult-invasive breast cancer including time from diagnosis to definitive surgery.