Ductal carcinoma in situ of the breast - Long term results from a twenty-year cohort

Abstract

IntroductionLong-term survival is excellent in ductal Carcinoma in situ (DCIS); whether or not we are over-treating DCIS has been a major public concern. This study aims at reviewing the long-term survival outcome of DCIS and identifying adverse prognosticators for DCIS. Patients and methodsPatients treated for DCIS between 1st January 1997 and 31st December 2016 were identified from a prospectively maintained database. Multivariate analysis was performed to evaluate the adverse factors for surgical margin involvement and local recurrence Results3042 female patients were treated for breast cancer over the 20-year study period, of which 203 (6.7%) had DCIS in final pathology. The median age of diagnosis was 53 year-old (Range 30–85). 57 (28.1%) were detected by screening mammogram, 101 had breast mass on presentation.132 (65%) patients received mastectomy and the remaining received breast conserving surgery (BCS); Sentinel lymph node biopsy was performed in 86 (42.4%) patients. 19 (9.4%) patients had positive resection margin, 18 were re-operated for clear resection margin. Multivariate analysis found that high grade DCIS is the only independent risk factors for margin involvement (HR 2.55, 95% CI 1.02–6.42).After median follow-up of 106 months (6–223 months), the overall survival was 97%. 4 (2%) patients developed local recurrence. Multivariate analysis found that positive surgical margin is the only independent factor of local recurrence (HR 9.58, 95% CI 1.43–64.18). ConclusionHigh grade DCIS is associated with increased risk of surgical margin involvement which is in turn an independent factor of local recurrence.