Abstract
Introduction: Screening mammography has led to a marked increase in detection of in situ breast tumors in the United States. The University of Southern California/Van Nuys Prognostic Index (USC/VNPI) predicts the recurrence rates of ductal carcinoma in situ (DCIS); however variations in tumor characteristics, USC/VNPI scores, receptor and human epithelial growth factor receptor (HER)-2/neu status across different ethnicities/races have not been well studied. This study aimed to evaluate the racial trends in incidence, patient demographics, tumor characteristics and treatment variations for patients with DCIS at a high volume teaching hospital. Methods: 395 women underwent surgical intervention for DCIS between 2000 and 2011. Their race/ethnicity was divided into five mutually exclusive categories and demographic and clinicopathological data was collected. Multivariate analysis was performed to evaluate variations in patient and tumor factors with respect to age, size and surgical management among different ethnicities and races. Results: 82.1% of Caucasian women underwent simple mastectomy with sentinel lymph node biopsy (SLNB) while lumpectomy with SLNB was highest in Hispanics (40%, p = 0.005). Overall, there was no significant difference in the incidence of receptor or HER-2/neu positivity, multicentricity, necrosis or grade of DCIS in the various racial groups, but there was a significant racial difference in the USC/VNPI scores (p in DCIS with respect to patient or tumor characteristics was observed, a racial difference in USC/VNPI score was identified among the Hispanic population. Additional studies are required to validate the significance of these findings.
Highlights
Introductionductal carcinoma in situ (DCIS) accounts for more than 20% of newly diagnosed breast cancers in the United States, in part due to increased mammography screening which began in the 1980’s [1]-[4]
Screening mammography has led to a marked increase in detection of in situ breast tumors in the United States
Demographic and clinicopathological data including age, sex, ethnic/racial origin, family history of breast cancer, BRCA 1or 2 gene mutation, pre-operative radiological findings, pre-operative clinical findings, type of surgery [lumpectomy versus simple mastectomy; sentinel lymph node biopsy (SLNB)], histopathological and receptor characteristics of the tumor were collected on all patients
Summary
DCIS accounts for more than 20% of newly diagnosed breast cancers in the United States, in part due to increased mammography screening which began in the 1980’s [1]-[4]. From 2004 to 2008, using data from the North American Association of Central Cancer Registries (NAACCR), Desantis et al [5] analyzed incidence rates by race/ethnicity, finding that invasive breast cancer rates were stable among all racial/ethnic groups, but not equal. The 5-year disease-free survival rate among Asian American/Pacific Islander women is reported as 90.3% and 77.5% in African-American women [5] While these differences in survival rates for invasive breast cancer suggest differences in tumor biology, stage of diagnosis, and access to treatment among different ethnicities, the same information for DCIS is lacking
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