Mastectomy For Ductal Carcinoma In Situ Research Articles

Mastectomy margins for ductal carcinoma-in-situ (DCIS): 18 Years of follow-up

BackgroundIn patients undergoing mastectomy for ductal carcinoma in situ (DCIS), the significance of a positive or close (<2 mm) margin and associated recurrence risk is unclear. The study sought to evaluate risk of recurrence in relation to the mastectomy surgical margin. MethodsA single institution retrospective review of patients with DCIS who underwent mastectomy between 2000 and 2010 was performed. Patient demographics, tumor biology, margin status and adjuvant therapy were recorded. The incidence of local recurrence (LR), distant metastasis were analyzed. ResultsA total of 282 patients with DCIS were identified. Overall, 12.3% of patients had a pathological positive/close margin (n = 9 tumor on ink and n = 36 <2 mm). Adjuvant radiation was administered to 11 patients with a positive or close margin. At a median follow-up of 12 years, LR was 3.4% (n = 10). None of the patients with LR had a positive or close margin. Additionally, none of the patients who received radiation developed LR. ConclusionRisk of recurrence after mastectomy for DCIS is low and appears to be unrelated to margin status or the use of radiation therapy.

P049. How common is upgrade from ductal carcinoma in situ (DCIS) to invasive carcinoma following mastectomy for DCIS only?

Background: According to NICE guidelines patients who are having mastectomy for DCIS should be offered sentinel lymph node biopsy (SLNB). The aim of our study was to investigate the incidence of upgrade from DCIS to Invasive carcinoma (IC) in the final post mastectomy histology and the proportion of patients who have a positive SLNB.

P084: Rate of positive sentinel node biopsy in patients having mastectomy for DCIS and feasibility of doing sentinel node biopsy at time of mastectomy and reconstruction

Introduction: Sentinel node biopsy (SNB) in patients having mastectomy for ductal-carcinoma-in-situ (DCIS) has been debated for years. 15-20% of DCIS cases have an invasive component at final histology after surgery (Karakatsanis, 2019). This audit determines rate of positive SNB in patients having mastectomy for DCIS and whether SNB can be done simultaneously with mastectomy and reconstruction.

Abstract P2-08-04: Bilateral mastectomy in ductal carcinoma in situ: 10-year analysis of national inpatient sample database

Abstract Background: The utilization of bilateral (B/L) mastectomy for ductal carcinoma in situ (DCIS) has been rising within the last two decades. This is occurring despite the lack of convincing evidence to support the positive impact of this approach on disease-specific or overall survival (OS.) Notably, the estimated annual risk of developing a contralateral breast cancer is only 0.1% per year. Method: This is a retrospective cohort analysis of National Inpatient Sample database between the years 2005 and 2014 of adult females who underwent B/L mastectomy. ICD-9-CM procedure codes were used to identify two subpopulations; those who had only DCIS without invasive breast cancer or high risk genetic syndrome (DCIS mastectomy) and all others. The aim of this study is to assess the demographic predictors of undergoing B/L mastectomy for DCIS. Statistical analysis done using STATA. Results: The total number of B/L mastectomies performed within the study period was 144,754, of which 24,766 (17.1%) were performed for DCIS with no invasive cancer and no high risk genetic syndrome. There was no significant difference between the two groups in age (average 52.8 years), length of stay (average 2.34 days) and total charge for hospitalization (average $51,209). Among DCIS mastectomy patients, 56.3% were &amp;gt;50 year-old and only 0.7% were 18-30 year-old, 80.7% were Caucasian and 7.5% were African American, 42% were from highest income quartile neighborhoods and 12.6% were from lowest income quartile neighborhoods and 77.8% had private insurance while 15.9% and 5.2% had Medicare and Medicaid, respectively. Interestingly, 95.6% of B/L mastectomies for DCIS were performed at urban centers, 63.6% in teaching hospitals and 64.2% were in large hospital by bed size. Univariate regression showed no significant predictive value for undergoing B/L mastectomy for DCIS indication by age, race, hospital geographic region, teaching status of hospital or hospital size. The odds of undergoing B/L mastectomy for DCIS was higher for age category for 30-50 year-old compared to 18-30 year-old (OR=2.6, p&amp;lt;0.001), highest income quartile compared to lowest (OR=1.28, p &amp;lt;0.001) and private insurance compared to Medicare (OR=1.3, p&amp;lt;0.001) and was lower for Charlson Comorbidity Index (CCI) ≥3 compared to 0 (OR=0.008, p&amp;lt;0.001). On multivariate analysis, age (OR=1.05, p&amp;lt;0.001), race (OR=1.5 for African American compared to Caucasian, p&amp;lt;0.001), highest income quartile (OR=1.19, p=0.03), higher CCI ≥3 (OR=0.005, p&amp;lt;0.001) and private insurance (OR=1.3, p=0.004) were independent predictors of undergoing B/L mastectomy for the diagnosis of DCIS. This disparity could be explained by the variability in anxiety levels among different groups and access to the financial resources needed to perform these procedures. In addition, we noted a progressive rise in charge of hospitalization for B/L mastectomy over the years (table). Conclusion: A significant proportion of B/L mastectomies are being performed for DCIS. While this approach has not convincingly yielded an OS benefit, it has significant clinical and psychological morbidity along with considerable financial toxicity. We found inequity in populations that receive this procedure by age, race, insurance status, income quartile and urban or rural location of center. Further studies would be helpful to delineate this disparity among patients and assess the utility of B/L mastectomy in the era of molecular prediction and superior therapeutic modalities. YearTotal charge of hospitalization ($)200528,722.3200632,192.5200738,492.2200845,168.5200945,752.2201053,326.5201156,128.0201259,118.7201372,193.6201473,783.9 Citation Format: Sindhu Janarthanam Malapati, Sunny RK Singh, Rohit Kumar, Jason Mouabbi, Ahmed Abdalla, Carrie Dul, Tarik Hadid. Bilateral mastectomy in ductal carcinoma in situ: 10-year analysis of national inpatient sample database [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-04.

Rate of sentinel lymph node biopsy in patients undergoing mastectomy for ductal carcinoma in situ with and without micro-invasion.

1065Background: Patients treated with mastectomy for ductal carcinoma in situ (DCIS) undergo sentinel lymph node biopsy (SLNB) due to the concern for invasive cancer on final histology and difficulty performing SLNB post mastectomy. However, the documented rate of positive SLN in patients with DCIS is about 1.3-13%. The purpose of the present study is to determine the rate of positive SLN in patients with DCIS undergoing mastectomy and to identify risk factors for positive SLN. Methods: Retrospective chart review included 377 patients treated with mastectomy for DCIS or DCIS-M registered within the Northwestern University Bioinformatics Center from 2000 to 2015. Correlation between patient and histologic features in relation to positive SLN was evaluated using univariate analysis. Results: Of the 377 patients evaluated 10 women had SN positivity, 2 with isolated tumor cells, 5 with macrometastasis, and 3 with micrometastasis. Only one patient had non-SN involvement (for a total of 3 nodes). The overall ra...

Oral Abstracts

Background: Aims of the current study were to identify which hospital organizational factors determine the variation in the use of immediate breast reconstruction (IBR) after mastectomy for ductal carcinoma in situ (DCIS) or invasive breast cancer and to investigate whether these factors explain the variation in IBR between hospitals in the Netherlands. Material and Methods: From the NABON Breast Cancer Audit (NBCA) patients with DCIS or primary invasive breast cancer without distant metastatic disease, diagnosed between January 1, 2011 and December 31, 2013 were selected. Hospital organizational factors were identified with an online web-based survey on different organization factors such as the number of weekly multidisciplinary team (MDT) meetings, number of (breast and plastic) surgeons in the hospital and the presence of plastic surgeons in weekly MDT. Logistic regression analyses were used to analyze whether the identified organizational factors significantly affected IBR rates. Patient, tumor and hospital organizational factors that demonstrated to significantly affect IBR rates in univariate analyses were included in the multivariate analyses. Results: In total, 72 hospitals (78% of all Dutch hospitals) participated in the survey. In these hospitals 16,471 female patients were treated with a mastectomy for DCIS (n = 1,980) or non-metastatic breast cancer (n = 14,491) during the study period. In total 20% (n = 3,244) of these patients underwent IBR for DCIS (mean, 42%; hospital range, 0−80%) or invasive breast cancer (mean, 17%; hospital range, 0−62%). Patients who underwent a mastectomy in a teaching (OR=2.6, 95% CI: 1.8−3.7) or university hospital (OR=10.8, 95% CI: 5.7–20.5) or in an intermediate volume (OR=2.0, 95% CI: 1.5−2.8) or high volume hospital (OR=3.0, 95% CI: 2.0−4.5) had a significantly higher chance of receiving IBR compared to patients treated in a district or low volume hospital, respectively. More often IBR was performed in hospitals having 3−4 MDT meetings/week organized compared to hospitals with 1−2 MDT meetings/week (OR=1.4, 95% CI: 1.1−1.8). The number of plastic surgeons in-house did not significantly affect the chance of IBR. In almost 70% of the hospitals, a plastic surgeon structurally attended the weekly MDT meeting, which was prognostic for performing more IBRs compared to MDTs with no or incidental plastic surgeon attendance (OR=3.89, 95% CI: 3.00–5.04). Conclusion: Hospital organizational factors affect the use of IBR and consequently could be subject for improvement to make IBR available to more breast cancer patients.

Abstract P5-17-05: Local recurrence rates after mastectomy undertaken for pure ductal carcinoma in situ

Abstract Currently over 30% of patients with ductal carcinoma in situ (DCIS) are treated by mastectomy. Local recurrence rates (LRR) after simple mastectomy for DCIS have historically been reported as low1. Recent UK and US data has indicated 5-year local recurrence rates after mastectomy for DCIS are increasing2. Skin sparing mastectomy (SSM) offers a better cosmetic outcome however there is little work in the literature comparing local recurrence rates between simple and SSM for pure DCIS. Local recurrence rates may be higher after SSM compared to simple mastectomy3. Aims: 1. To evaluate what local recurrence rates were after mastectomy performed for pure DCIS. 2. To compare LRR in simple against SSM. Methods: We undertook a retrospective analysis of all patients who underwent a mastectomy for pure DCIS at one breast unit between 2000-2010. Operation reports were reviewed and data collected on the type of mastectomy and reconstruction used. Pathology reports were reviewed and the histological type, grade, size of DCIS as well as the presence of micro-invasion, excision margin and molecular phenotype were recorded. We excluded those patients who were having surgery for recurrent ipsilateral disease, gynaecomastia and risk reduction. Results: One hundred and ninety-nine patients had a mastectomy to treat pure DCIS between 2000-2010. Median follow up time was 65 (0-152) months. 102 patients had an SSM compared to 97 who had a simple mastectomy. The mean age was younger in the SSM group 53 as opposed to 61 (p = &amp;lt;0.01, t-test). Overall local recurrence rates were 3.1% at 5 years and 5.6% at 8 years. Fiver-year contralateral recurrence rates were 4.2% and 8.5% at 8 years. All of the recurrences occurred in the SSM group which had 8/102 local recurrences compared to 0/97 in the simple mastectomy group. All 8 of the recurrence were invasive ductal carcinoma with a median disease free survival time of 55 months. Univariate analysis demonstrated that a young age and close margins predicted recurrence. Conclusion: Our overall 5-year local recurrence rate was 3.1%. This is higher than historical data however in line with emerging UK and US data. Five-year LRR was significantly higher after SSM 5.9% compared to simple mastectomy 0%. All recurrences were invasive disease, which represented a loss of control of disease. Further work is needed to evaluate if there is a benefit of undertaking post reconstruction mammography to detect recurrences whilst still in situ disease. Our work corroborates with the literature highlighting the importance of achieving clear margins to prevent recurrence.

The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors

BackgroundThe objective of this retrospective study was to determine the incidence of recurrence of breast cancer after mastectomy for ductal carcinoma in situ (DCIS) in our institution, and to evaluate the associated risk factors while comparing them to those proposed in the literature. MethodsThe files of 218 patients who had undergone mastectomy for pure DCIS or DCIS with micro-invasion at Centre Eugène Marquis between January 2003 and November 2013 were compared for: age at diagnosis, type of mastectomy and immediate reconstruction, tumor characteristics, and the evaluation of the sentinel axillary lymph node. The mean follow-up period was 30.5 months. ResultsIn a mean period of 39.13 months, 8 patients (3.67%) developed a recurrence post-mastectomy, 2 of whom with distant metastasis. Two others developed distant metastases subsequently during treatment. All 4 died due to progression of metastases, while the other 4 are alive and disease-free after treatment. The only risk factor was young age at initial diagnosis (<40 years). None of the other factors described in the literature, such as high grade or diffuse disease, comedo-necrosis, positive margins or micro-invasion were statistically significant. ConclusionThe recurrence of breast cancer after mastectomy for DCIS is rare, however, it carries a high mortality rate for those who do relapse. Patients who have high risk factors such as young age at diagnosis and high risk tumor factors should be followed closely for signs of recurrence and/or metastasis.

Ramifications of Breast-Conserving Surgery for Ductal Carcinoma in Situ

As more women undergo screening mammography, the number who receive diagnoses of ductal carcinoma in situ (DCIS) has risen. Breast-conserving surgery (BCS) is a reasonable alternative to mastectomy for DCIS, as both approaches yield similar long-term mortality outcomes (JW Oncol Hematol Apr 19 2011); however, the recurrence risk associated with BCS necessitates ongoing surveillance. In a …

The effect of system-level access factors on receipt of reconstruction among Latina and white women with DCIS

Treatment decisions associated with ductal carcinoma in situ (DCIS), including the decision to undergo breast reconstruction, may be more problematic for Latinas due to access and language issues. To help understand the factors that influence patients' receipt of reconstruction following mastectomy for DCIS, we conducted a population-based study of English- and Spanish-speaking Latina and non-Latina white women from 35 California counties. The objectives of this study were to identify the role of ethnicity and language in the receipt of reconstruction, the relationship between system-level factors and the receipt of reconstruction, and women's reasons for not undergoing reconstruction. Women aged 18 and older, who self-identified as Latina or non-Latino white and were diagnosed with DCIS between 2002 and 2005 were selected from eight California Cancer Registry (CCR) regions encompassing 35 counties. Approximately 24 months after diagnosis, they were surveyed about their DCIS treatment decisions. Survey data were merged with CCR records to obtain tumor and treatment data. The survey was successfully completed by 745 women, 239 of whom had a mastectomy and represent the sample included in this study. Whites had a higher completion rate than Latinas (67 and 55%, respectively). Analysis included descriptive statistics and logistic regression modeling. Mean age was 54 years. A greater proportion of whites had reconstruction (72%) compared to English-speaking Latinas (69%) and Spanish-speaking Latinas (40%). Multivariate analysis showed that women who were aged 65 and older, unemployed, and had a lower ratio of plastic surgeons in their county were less likely to have reconstructive surgery after mastectomy. The most frequent reasons mentioned not to receive reconstruction included lack of importance and desire to avoid additional surgery. Although ethnic/language differences in treatment selection were observed, multivariable analysis suggests that these differences could be explained by differential employment levels and geographic availability of plastic surgeons.

Analyzing the Risk of Recurrence after Mastectomy for DCIS: A New Use for the USC/Van Nuys Prognostic Index

Patients with ductal carcinoma in situ (DCIS) who are treated with mastectomy seldom recur locally or with metastatic disease. When patients with DCIS recur with invasive cancer, they are upstaged and their lives are threatened. We questioned whether histopathologic data could be used to predict these infrequent events. We reviewed a prospective database of 1,472 patients with pure DCIS. All patients were scored from 4 to 12 using the USC Van Nuys Prognostic Index, an algorithm based on DCIS size, nuclear grade, necrosis, margin width, and patient age. Probabilities of recurrence and death were calculated using the Kaplan-Meier method. A total of 496 patients with pure DCIS were treated with mastectomy. None received any form of postmastectomy adjuvant treatment. Average follow-up was 83months. Eleven patients developed recurrences, all of whom scored 10-12 using the USC/VNPI. No patient who scored 4-9 recurred. All 11 patients who recurred had multifocal disease and comedo-type necrosis. The probability of disease recurrence after mastectomy for patients scoring 10-12 was 9.6% at 12years, compared with 0% for those scoring 4-9. There was no difference in overall survival. There were no recurrences among mastectomy patients who scored 4-9 using the USC/VNPI. Patients scoring 10-12 were significantly more likely to develop recurrence after mastectomy. At risk were young patients with large, high-grade, and multifocal or multicentric tumors. For every 100 patients with USC/VNPI scores of 10-12, 10 patients will recur by 12years and 2-3 will develop metastatic disease.

Recurrence after Mastectomy for Ductal Carcinoma in Situ

Mastectomy has long been a standard option for patients with ductal carcinoma in situ (DCIS). It is preferentially chosen by some women and may be suggested for individuals with recurrent, multifocal, or multicentric disease. We chose to evaluate our recent experience with mastectomy for DCIS. A retrospective review was conducted of 83 patients (87 breasts) from 1995 to 2006 who underwent mastectomy for DCIS. Mastectomy for DCIS was performed in 49 postmenopausal, 33 premenopausal, and one male patient. The average age was 53 years and the mean follow up was 4.5 years. Sentinel lymph node (SLN) biopsy was performed on 44 cases; positive nodes were identified in two. Intraoperative analyses of SLN were all negative. Only one patient had ipsilateral recurrence of the skin (1.1%). DCIS with microinvasion was noted in 32 per cent of the patients; none of these patients had ipsilateral recurrence. Three patients had positive microscopic margins; none have recurred to date. These results confirm the usefulness of mastectomy for patients with DCIS. We recommend SLN biopsy without intraoperative touch prep analysis. Additional treatment may not be required in patients with microinvasion, positive or close margins because our series shows no local recurrence in these patients.

Long-term outcome after postmastectomy radiation therapy for the treatment of ductal carcinoma in situ of the breast.

Postmastectomy radiation therapy may be recommended for patients with a high risk for local recurrence after mastectomy for ductal carcinoma in situ (DCIS). However, long-term outcomes after postmastectomy radiation therapy are not well described. This study was performed to determine long-term outcomes in patients treated with radiation therapy after mastectomy for DCIS. The authors reviewed the records of all patients with breast cancer treated with postmastectomy radiation therapy between 1978 and 1992. Of 287 total patients treated, three (1%) were for DCIS. These three patients had diffuse microcalcifications on screening mammography. The reason for postmastectomy radiation therapy was a potentially increased risk for local recurrence because of a positive resection margin after mastectomy for DCIS. Surgery consisted of a total mastectomy (n = 2) or a modified radical mastectomy (n = 1). Radiation therapy consisted of 4275-5000 cGy to the chest wall in 200-225 cGy fractions. The energy used was 6-MV photons (n = 2) or 15-MV photons (n = 1). No regional nodal irradiation was used. Bolus was applied to the chest wall every other day in one of the three patients. One patient was treated with a scar boost after chest wall irradiation (boost dose, 1000 cGy; total dose, 5275 cGy). The median age for the three patients was 46 years (range, 41-68 years). No patient received adjuvant chemotherapy or hormonal therapy. With a minimum follow-up of 7.1 years (median, 7.4 years; range, 7.1-19.4 years), no local-regional recurrence or evidence of metastatic disease developed in any of the patients. No long-term complication from radiation therapy was noted, and no contralateral breast cancer developed. All patients were alive and free of relapse at the last follow-up. The use of radiation therapy in this group of three patients has shown no evidence of relapse with a minimum of 7.1 years of follow-up. The authors conclude that radiation therapy may be indicated after mastectomy for DCIS to reduce the risk of recurrence for high-risk patients.

Ductal Carcinoma in Situ Recurrent on the Chest Wall After Mastectomy

Two patients with local recurrence on the chest wall subsequent to mastectomy for ductal carcinoma in situ (DCIS) are presented. One recurrence was invasive carcinoma and the second was DCIS. Excision and chest wall irradiation, together with chemotherapy in the first patient, have provided subsequent disease-free survivals of 6 and 12 years respectively. Although mastectomy for DCIS is almost always curative, the possibility of local recurrence requires careful surveillance.

Local Recurrence After Mastectomy for Ductal Carcinoma In Situ

Abstract: Local recurrence after mastectomy for invasive cancer generally carries a poor prognosis. Local recurrence after mastectomy for ductal carcinoma in situ (DCIS) is rare and its impact on survival is unknown. Sixty-eight patients were treated with mastectomy for DCIS at the Fox Chase Cancer Center between 1985 and 1996, and only one of these developed a chest wall recurrence. An additional five patients treated with mastectomy at other institutions and referred to Fox Chase after local recurrence were also identified. These six patients had only DCIS as their primary pathology. Four of the six patients were premenopausal (median age 42 years). The median interval to local recurrence was 5.0 years (2.8–9.3 years). The median follow-up from initial diagnosis was 10.5 years (4.3–26.7 years) and 5.2 years (1.4–17.6 years) from recurrence. All of the recurrences were invasive and treatment included wide local excision with radiotherapy in all of the patients followed by adjuvant chemotherapy for the premenopausal patients. None of the patients had metastatic disease at presentation. The disease-free survival from initial recurrence was 83% and 63% at 5 and 10 years, respectively. The 5- and 10-year survival following local recurrence was 80%. One patient died 3.6 years after recurrence with metastatic disease, while a second patient developed metastatic disease 11.8 years after her initial recurrence. The remaining four patients are alive (NED), ranging from 1.4 to 10.7 years following their local recurrence. Local recurrence following mastectomy for DCIS is rare, usually invasive, and may have a long interval to failure. Salvage using conventional multimodality therapy appears to result in long-term survival.