Abstract
Mastectomy is effective treatment for ductal carcinoma in situ (DCIS) but some women will develop chest wall recurrence. Most chest wall recurrences that develop after mastectomy are invasive cancer and are associated with poorer prognosis. Past studies have been unable to identify factors predictive of chest wall recurrence. Therefore, it remains unclear if a subset exists of women with DCIS treated by mastectomy experience a high rate of recurrence in whom more aggressive treatment may be of benefit. We report outcomes of all women in Ontario (N = 1,546) diagnosed with pure DCIS from 1994 to 2003 treated with mastectomy without radiotherapy and evaluate factors associated with the development of chest wall recurrence. Treatments and outcomes were validated by chart review. Proportional differences were compared using Chi square analyses. Survival analyses were used to study the development of chest wall recurrence in relation to patient and tumor characteristics. Median follow-up was 10.1 years. Median age was 57.1 years. 36 patients (2.3%) developed chest wall recurrence. The 10-year actuarial chest wall recurrence-free survival rates and invasive chest wall recurrence-free survival rates were 97.6 and 98.6%, respectively. There was no difference in cumulative 10 year rates of chest wall recurrence by age at diagnosis (<40 years = 5.2%, 40–44 years = 1.3%, 45–50 years = 2.9%, >50 years = 2.1%; p = 0.19), nuclear grade (high = 3.0%, intermediate = 1.4%, low = 1.0%, unreported = 2.5%; p = 0.41), or among women with close or positive resection margins (positive = 3.0%, 2 mm or less = 1.4%, >2 mm = 1.5%, unreported = 2.8%; p = 0.51). On univariate and multivariable analysis, none of the factors were significantly associated with the development of chest wall recurrence. In this population cohort, individuals treated by mastectomy experienced low rates of chest wall recurrence. We did not identify a subset of patients with a high rate of chest wall recurrence, including those with positive margins.
Highlights
Ductal carcinoma in situ (DCIS), a non-invasive breast cancer, comprises about 25% of mammographicallydetected breast cancers (Ernster et al 2002)
Past studies are limited in their ability to evaluate factors associated with an increased risk of chest wall recurrence due to the inclusion of few patients often from a single institution, inclusion of cases treated by either breast-conserving surgery or mastectomy or short follow-up intervals with subsequent few events and limited statistical power (Carlson et al 2007; Owen et al 2013; Chadha et al 2012; Fitzsullivan et al 2013; Meijnen et al 2008; Godat et al 2009; Rashtian et al 2008; Chan et al 2011; Childs et al 2013; Kelley et al 2011; Silverstein et al 1995; Spiegel and Butler 2003; Vargas et al 2005)
It remains unclear if a subset of individuals with DCIS treated by mastectomy, including those with close or positive resection margins, has an increased risk of chest wall recurrence such that post-mastectomy radiotherapy might be of benefit
Summary
Ductal carcinoma in situ (DCIS), a non-invasive breast cancer, comprises about 25% of mammographicallydetected breast cancers (Ernster et al 2002). Past studies are limited in their ability to evaluate factors associated with an increased risk of chest wall recurrence due to the inclusion of few patients often from a single institution (which may not be representative of the outcomes of a population of women with DCIS), inclusion of cases treated by either breast-conserving surgery or mastectomy or short follow-up intervals with subsequent few events and limited statistical power (Carlson et al 2007; Owen et al 2013; Chadha et al 2012; Fitzsullivan et al 2013; Meijnen et al 2008; Godat et al 2009; Rashtian et al 2008; Chan et al 2011; Childs et al 2013; Kelley et al 2011; Silverstein et al 1995; Spiegel and Butler 2003; Vargas et al 2005) As a result, it remains unclear if a subset of individuals with DCIS treated by mastectomy, including those with close or positive resection margins, has an increased risk of chest wall recurrence such that post-mastectomy radiotherapy might be of benefit. Our objective is to evaluate factors associated with the risk of chest wall recurrence after treatment by mastectomy, including the impact of close resection margins
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