Outcome Of Ductal Carcinoma Research Articles

The Role of Residential Segregation in Treatment and Outcomes of Ductal Carcinoma in Situ of the Breast.

It remains unclear if residential segregation impacts on clinical treatment and outcomes for ductal carcinoma in situ (DCIS), a nonobligate precursor to invasive breast cancer (IBC). This population-based retrospective cohort study included adult non-Hispanic White (NHW) and Black (NHB) women diagnosed with unilateral DCIS between January 1990 and December 2015, followed through December 2016, and identified from the Surveillance, Epidemiology, and End Results dataset. County-level racialized economic segregation was measured using the Index of Concentration at the Extremes. Multilevel logistic regression and Cox proportional hazards regression accounting for county-level clustering were used to estimate the odds ratios (ORs) of local treatment, and hazard ratios (HRs) of subsequent IBC and mortality. Of 103,898 cases, mean age was 59.5 years, 12.5% were NHB, 87.5% were NHW, 97.5% underwent surgery, 64.5% received radiotherapy following breast-conserving surgery, 7.1% developed IBC, and 18.6% died from all causes. Among women living in the least vs most privileged counties, we observed higher odds of receiving mastectomy (vs breast-conserving surgery) (OR=1.51, 95% CI 1.35-1.69; Ptrend<0.001) and radiation therapy following breast-conserving surgery (OR=1.27, 95% CI 1.07-1.51; Ptrend<0.01); the risk was higher in subsequent ipsilateral IBC (HR=1.16, 95% CI 1.02-1.32; Ptrend=0.04), not in breast cancer-specific mortality (HR=1.04, 95% CI 0.88-1.23; Ptrend=0.56). The results provide evidence for disparities in clinical treatment for DCIS and prognostic outcomes among women in racially and economically segregated counties. Our findings may inform geographically targeted multilevel interventions to reduce breast cancer burden and improve breast cancer care and equity.

Patterns of treatment and outcome of ductal carcinoma in situ in the Netherlands

PurposeTo spare DCIS patients from overtreatment, treatment de-escalated over the years. This study evaluates the influence of these developments on the patterns of care in the treatment of DCIS with particular interest in the use of breast conserving surgery (BCS), radiotherapy following BCS and the use and type of axillary staging.MethodsIn this large population-based cohort study all women, aged 50–74 years diagnosed with DCIS from January 1989 until January 2019, were analyzed per two-year cohort.ResultsA total of 30,417 women were diagnosed with DCIS. The proportion of patients undergoing BCS increased from 47.7% in 1995–1996 to 72.7% in 2017–2018 (p < 0.001). Adjuvant radiotherapy following BCS increased from 28.9% (1995–1996) to 89.6% (2011–2012) and subsequently decreased to 74.9% (2017–2018; p < 0.001). Since its introduction, the use of sentinel lymph node biopsy (SLNB) increased to 63.1% in 2013–2014 and subsequently decreased to 52.8% in 2017–2018 (p < 0.001). Axillary surgery is already omitted in 55.8% of the patients undergoing BCS nowadays. The five-year invasive relapse-free survival (iRFS) for BCS with adjuvant radiotherapy in the period 1989–2010, was 98.7% [CI 98.4% – 99.0%], compared to 95.0% [CI 94.1% –95.8%] for BCS only (p < 0.001). In 2011–2018, this was 99.3% [CI 99.1% – 99.5%] and 98.8% [CI 98.2% – 99.4%] respectively (p = 0.01).ConclusionsThis study shows a shift toward less extensive treatment. DCIS is increasingly treated with BCS and less often followed by additional radiotherapy. The absence of radiotherapy still results in excellent iRFS. Axillary surgery is increasingly omitted in DCIS patients.

380 Poster - Patterns of treatment and outcome of ductal carcinoma in situ for population-based screened women

380 Poster - Patterns of treatment and outcome of ductal carcinoma in situ for population-based screened women

Outcomes of Ductal Carcinoma In Situ According to Detection Modality: A Multicenter Study Comparing Recurrence Between Mammography and Breast US

The purpose of this study was to determine whether disease recurrence and intrinsic characteristics of ductal carcinoma in situ (DCIS) are associated with the imaging method of detection in asymptomatic women. This multicenter, retrospective study included 844 women treated for asymptomatic DCIS who had pre-operative mammography and breast ultrasonography (US) studies available. Of the 844 women, 25 (3.0%) developed recurrences. Patients in the US group had significantly lower 5- and 10-y recurrence-free survival (RFS) rates compared with patients in the mammography group (p = 0.011). US-detected DCIS showed significantly lower 5-and 10-y RFS rates compared with mammography-detected DCIS in patients <50 y or with mammographically dense breasts (p = 0.002 and 0.002, respectively). US as the detection modality (hazard ratio [HR]: 4.451; 95% confidence interval [CI]: 1.530, 12.950; p = 0.006) and HER2 positivity (HR: 4.036; 95% CI: 1.438; 11.330; p = 0.008) were significantly associated with recurrence. We concluded that US as the detection modality and HER2 positivity were significantly associated with recurrence in patients treated for asymptomatic DCIS.

Impacts of Neighborhood Characteristics on Treatment and Outcomes in Women with Ductal Carcinoma In Situ of the Breast.

Background: This study examines associations of neighborhood characteristics with treatment and outcomes of ductal carcinoma in situ (DCIS) of the breast.Methods: From the Missouri Cancer Registry, we identified 9,195 women with DCIS diagnosed between 1996 and 2011. A composite index using U.S. Census data and American Community Survey data was developed to assess census tract-level socioeconomic deprivation, and rural-urban commuting area codes were used to define rural census tracts. ORs and 95% confidence intervals (CIs) of the treatment were estimated using logistic regression. Hazard ratios (HRs) of DCIS outcomes were estimated using Cox proportional hazards regression.Results: Women in the most socioeconomically deprived census tracts were more likely than those in the least deprived to have mastectomy (OR = 1.44; 95% CI, 1.25-1.66; P trend < 0.0001), no surgery (OR = 1.54; 95% CI, 1.02-2.30; P trend = 0.04), no radiotherapy post-breast conserving surgery (OR = 1.90; 95% CI, 1.56-2.31; P trend<0.0001), delayed radiotherapy (OR = 1.26; 95% CI, 1.01-1.57; P trend = 0.02), and ipsilateral breast tumors (HR = 1.59; 95% CI, 1.07-2.38; P trend = 0.03). There was no significant difference in risk of contralateral breast tumors. Compared with urban women, rural women had significantly higher odds of underutilization of radiotherapy (OR = 1.29; 95% CI, 1.08-1.53). Rural locations were not associated with risk of ipsilateral or contralateral breast tumors.Conclusions: Neighborhood socioeconomic deprivation was associated with higher risks of suboptimal treatment and ipsilateral breast tumors. While DCIS treatment significantly varied by rural/urban locations, we did not observe any statistically significant rural-urban differences in risks of second breast tumors.Impact: Neighborhood attributes may affect treatment and outcomes of patients with DCIS. Cancer Epidemiol Biomarkers Prev; 27(11); 1298-306. ©2018 AACR.

Abstract P4-15-12: Evaluating the significance of the Van Nuys prognostic index for the management of ductal carcinoma in situ – one center's experience

Abstract Aim: This was to assess the treatment outcomes of ductal carcinoma of the breast (DCIS) based on the Van Nuys Prognostic Index. Material and Methods: 634 consecutive patients with DCIS were treated at the Warsaw Cancer Center, Poland between 1996 and 2008 based on the VNPI score. Tumorectomy without radiotherapy (T) was performed in 123 (20%) patients, breast conserving treatment (BCT) in 206 (32%) and mastectomy (M) in 305 (48%). Disease-free survival (DFS) and overall survival (OS) were analysed within 3 groups and a multivariate analysis was performed to determine the most important factor affecting local relapse. Results: 5-year, 10-year and 15-year DFS in the M group were respectively 98%, 97% and 97% whilst 5-year, 10-year and 15-year DFS in the BCT group were respectively 91%, 87% and 80%. 5-year, 10-year and 15-year DFS in the T group were respectively 92%, 73% and 67%. Local recurrence was observed in 54 patients. In 40% cases this was noninvasive and in 60 % invasive. Only 4 of 54 patients with recurrence died due to breast cancer. 5-year, 10-year and 15-year OS in the M group were respectively 96%, 92% and 89%. 5-year, 10-year and 15-year OS in the BCT group were respectively 99%, 94% and 85%. 5-year, 10-year and 15-year OS in the T group were respectively 95%, 90% and 73% (p=0.422). Tumor size assessed by mammography was the only variable affecting DFS. Conclusions: Treatment outcomes of DCIS based on the Van Nuys Prognostic Index are comparable with those cited the literature, however, the recurrence rate in the T group seems to be very high. This group requires that new risk factors be sought for prior to taking a treatment decision. Citation Format: Niwinska A, Galecki J, Nagadowska M, Piechocki J, Kunkiel M, Jagiello-Gruszfeld AI, Nowecki Z. Evaluating the significance of the Van Nuys prognostic index for the management of ductal carcinoma in situ – one center's experience [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-15-12.

Impact of hormonal status on outcome of ductal carcinoma in situ treated with breast-conserving surgery plus radiotherapy: Long-term experience from two large-institutional series

BackgroundDuctal carcinoma in situ (DCIS) is a heterogeneous disease, for which the best adjuvant treatment is still uncertain. Many attempts of risk-groups stratification have been made over time, developing prognostic scores to predict risk of local recurrence (LR) on the basis of features such as age, final surgical margins (FSM) status, grade, and tumor size. The aim of our analysis was to evaluate the patterns of recurrence from a two large-institutional retrospective series. Patients and methodsWe collected data on 457 patients treated with BCS and adjuvant RT between 1990 and 2012. Final analysis was performed on 278 patients, due to missing data about hormonal status (HS). Patients were treated at the Radiation Oncology Unit of the University of Florence (n = 195), and S. Maria Annunziata Hospital (n = 83) (Florence, Italy). ResultsAt a median follow up time of 10.8 years (range 3–25), we observed 20 LR (7.2%). The 5-year and 10-year LR rates were 4.9% and 10.2%, respectively. At Cox regression univariate analysis, estrogen receptor (ER) positive status (p = 0.001), HS positive (p = 0.003), and FSM <1 mm (p = 0.0001) significantly impacted on LR. At Cox regression multivariate analysis positive ER status maintained a protective role (p = 0.003), and FSM status <1 mm its negative impact (p = 0.0001) on LR rate. ConclusionsOur experience confirmed the wide heterogeneity of DCIS. Inadequate FSM and negative ER status negatively influenced LR rates. Tumor biology should be integrated in adjuvant treatment decision-making process.

Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race.

To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS). The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race. There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95% CI 0.99-1.35) or endocrine therapy (OR 1.19; 95% CI 0.94-1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95% CI 0.92-1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95% CI 1.55-2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95% CI 1.15-2.50) and a comparable risk of CBTs (HR 1.19; 95% CI 0.84-1.68), which were independent of pathological features and treatment. Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.

72P Biologic behavior and long-term outcomes of ductal carcinoma in situ with micro-invasion

72P Biologic behavior and long-term outcomes of ductal carcinoma in situ with micro-invasion

Outcome of Ductal Carcinoma in Situ in Patients with or Without p53 Mutations

Objectives p53 is a tumor suppressor gene and plays an important role in the etiology of breast cancer. The aim of this study is to clarify clinical significance of p53 in Ductal Carcinoma in situ (DCIS), and discuss about survival effect. Methods The study subjects, 69 women with breast cancer, were a subset of patients operated from Jan 2005 to Dec 2006. We used a cutoff of 10% to distinguish between positive and negative p53 staining. The University of Southern California (USC)/Van Nuys Prognostic Index (VNPI) were compared with 2 categories of p53. Results The positivity of p53 was found in 20 patients (29.0%) in DCIS. And negativity of p53 was found in 49 patients (71.0%). And 15 patients (21.7%) had a low USC/VNPI score, 42 patients (60.9%) intermediate and 12 patients (17.4%) a high score. The positivity of p53 was correlated with high USC/VNPI (&lt;italic&gt;P&lt;/italic&gt; = 0.001). The univariate analysis for prognostic factors associated with Disease Free Survival (DFS) revealed that patients with p53 positivity show shorter Disease Free Survival (DFS) than patients with p53 negativity (&lt;italic&gt;P&lt;/italic&gt; = 0.013) and USC/VNPI was also statistically significant (&lt;italic&gt;P&lt;/italic&gt; = 0.030). Conclusions According to our study, p53 was associated with high USC/VNPI. These findings suggest that p53 can be used to classify DCIS into at least two subtypes with differing prognoses.

Impact of race and ethnicity on features and outcome of ductal carcinoma in situ of the breast

The impact of race and ethnicity on the biologic features and outcome variables of women who are diagnosed with preinvasive breast cancer-ductal carcinoma in situ (DCIS)-has not been addressed widely in the published literature. Patient demographic, clinical, and pathologic features and outcome variables were analyzed with respect to the patient's initial self-reported race/ethnicity among women who received treatment for a diagnosis of pure DCIS from 1996 to 2009. Of 1902 patients, 1411 were white (74.2%), 214 were African American (11.3%), 175 were Hispanic (9.1%), and 102 were Asian/Pacific Islander (5.4%). The majority of patients were between ages 41 and 70 years (83%). Patients of Hispanic and Asian/Pacific Islander descent were significantly younger than white and African American patients (P < .001). DCIS size and grade, the presence of necrosis, and the frequency of breast-conserving surgery did not differ significantly between groups. African American patients aged >70 years and Hispanic patients aged <50 years were significantly more likely to have estrogen receptor-positive DCIS than patients of other races in the same age categories (P < .001). Adjuvant radiotherapy and tamoxifen were received significantly less often by white women (P < .001). At a median follow-up of 4.8 years (range, 1-14 years), recurrence rates and the development of contralateral breast cancer did not differ significantly among racial/ethnic groups when stratified by treatments received. There was variation in age at presentation, biologic features, and treatment of DCIS among the different ethnic groups. Additional studies with larger numbers of ethnic minority patients are needed to confirm whether the consistent application of evidence-based treatment practices presents an opportunity for reducing disparities in patients with DCIS.

Long-term Outcomes of Ductal Carcinoma In Situ of the Breast: A Systematic Review and Meta-analysis

Materials/Methods: A meta-analysis of observational studies was conducted. Studies eligible for inclusion reported data where all subjects (or subgroups): (1) were diagnosed with pure DCIS, (2) had a minimum median/mean follow-up of 10 years, (3) had details provided on type of surgery (mastectomy, breast conservation or biopsy only) and radiation therapy (RT) received, and (4) had ipsilateral local recurrence (ILR) by local treatment reported. All published studies were considered; no language, publication date or study-type restrictions were imposed. Evaluation of the heterogeneity of all studies, individually and by treatment type, and the calculation of the pooled proportions (overall and by treatment type) was undertaken by variance weighting according to the method described by Berry for small numbers. Fixed or random effects models were used as appropriate with confidence intervals (95% CIs) of pooled proportions derived from the normal approximation of the binomial.

Prognostic markers and long-term outcomes in ductal carcinoma in situ of the breast treated with excision alone

Increased use of breast cancer screening has led to an increase in the number of diagnosed cases of ductal carcinoma in situ (DCIS). However, there is no definite way to predict progression or recurrence of DCIS. We analyzed the significance of biological markers and tumor characteristics in predicting recurrence in a large series of DCIS patients with long-term follow-up treated with breast conservation surgery (BCS) alone. Clinical and pathological data were analyzed for 141 patients who underwent BCS for DCIS. All had negative surgical margins. Using local disease recurrence as an endpoint, we sought to determine the prognostic significance of several histopathological characteristics (tumor size, presence of necrosis, and subtype) and biological markers (estrogen receptor, progesterone receptor, and Her-2/neu.) At a median follow-up of 122 months (maximum follow-up, 294 months), 60 recurrences occurred, with a median time to recurrence of 191 months. On multivariate analysis, Her-2 positivity (3+) was found to be significantly associated with reduced time to tumor recurrence (P = .028). Tumor size and higher grade were marginally statistically significant (P = .099, P = .070). Neither necrosis nor tumor pathological characteristics were found to be significantly related to time to disease recurrence. Our results suggested that status of Her-2/neu, larger tumor size, and higher nuclear grade were significantly correlated with time to tumor recurrence in patients treated with BCS alone. Using logistical analyses, no significant correlation was found between tumor pathological characteristics and disease recurrence.

Effect of Radiotherapy Boost and Hypofractionation on Outcomes in Ductal Carcinoma In Situ

Effect of Radiotherapy Boost and Hypofractionation on Outcomes in Ductal Carcinoma In Situ

Long-Term Outcomes of Ductal Carcinoma in Situ

Incidence of ductal carcinoma in situ (DCIS) has risen substantially during the last 2 decades as a result of screening mammography. However, mammographically detected DCIS is often clinically silent and substantially less extensive than the large DCIS lesions that once were common at diagnosis. In addition, therapeutic approaches to DCIS have evolved: For most patients, breast conservation (i.e., lumpectomy and …

Local Outcomes in Ductal Carcinoma In Situ Based on Patient and Tumor Characteristics

The term ductal carcinoma in situ (DCIS) encompasses a heterogeneous group of lesions that differ in their clinical behavior. Clinical factors such as symptomatic presentation and young age are associated with an increased risk of local recurrence in patients with DCIS managed with breast-conserving therapy. Treatment factors such as wider surgical margins, the use of radiation therapy, and the use of tamoxifen reduce the local recurrence risk. Pathological characteristics such as larger lesion size, high nuclear grade, comedo necrosis, and involved margins are associated with an increased risk of local recurrence in many studies. However, there are complex interactions between these pathological risk factors and other parameters such as treatment and length of follow-up. In fact, the magnitude of the effect of these pathological features on local recurrence risk is modified by these other factors. Analysis of genetic and molecular alterations as well as study of the microenvironment associated with DCIS are important avenues of research that may provide new insights into DCIS recurrence and progression risk, and this in turn may lead to new strategies for treatment and prevention.

Effect of radiotherapy boost and hypofractionation on outcomes in ductal carcinoma in situ

Boost radiotherapy (RT) improves outcomes for patients with invasive breast cancer, but whether this is applicable to patients with pure ductal carcinoma in situ (DCIS) is unclear. This study examined outcomes from whole breast RT, with or without a boost, and the impact of different dose-fractionation schedules in a population-based cohort of women with pure DCIS treated with breast-conserving surgery (BCS). Data was analyzed for 957 subjects diagnosed between 1985 and 1999. RT use was analyzed over time. Ten-year Kaplan-Meier local control (LC), breast cancer specific survival (BCSS), and overall survival (OS) were compared using the log-rank test. Cox regression modeling of LC was performed. Median follow-up was 9.3 years. Of the patient cohort 475 (50%) had no RT (NoRT) after BCS, 338 (35%) had RT without a partial breast boost (RTNoB), and 144 (15%) had RT with boost (RT + B). Subjects with risk factors of local recurrence were more likely to receive RT. Subjects receiving adjuvant RT had a trend toward improved LC (15-year LC: NoRT 87%; RTNoB 94%; RT + B 91%; P = .065). Multivariable analysis showed that RT with or without a boost was significantly associated with improved LC (HR, 0.29 and 0.38, respectively, compared with NoRT, P = .025), with no difference associated with a boost or different dose-fractionation schedules. Adjuvant RT improves local control in patients with DCIS treated with BCS. Hypofractionation is as effective as standard fractionation schedules. Boost RT was not associated with improved LC compared with whole breast RT alone. Cancer 2011. © 2010 American Cancer Society.

Ductal Carcinoma In Situ of the Breast: A Systematic Review of Incidence, Treatment, and Outcomes

The National Institutes of Health Office of Medical Applications of Research commissioned a structured literature review on the incidence, treatment, and outcomes of ductal carcinoma in situ (DCIS) as a background article for the State of the Science Conference on Diagnosis and Management of DCIS. Published studies were identified and abstracted from MEDLINE and other sources. We include articles published between 1965 and January 31, 2009; 374 publications were identified that addressed DCIS incidence, staging, treatment, and outcomes in adult women. In the United States, DCIS incidence rose from 1.87 per 100 000 in 1973-1975 to 32.5 in 2004. Incidence increased in all ages but more so in women older than 50 years. Increased use of mammography explains some but not all of the increased incidence. Risk factors for incident DCIS include older age and family history. Although tamoxifen treatment prevented both invasive breast cancer and DCIS, raloxifene treatment decreased incidence of invasive breast cancer but not DCIS. Among patients with DCIS, magnetic resonance imaging was more sensitive than mammography for detecting multicentric disease and estimating tumor size. Because about 15% of patients with DCIS identified on core needle biopsy are diagnosed with invasive breast cancer after excision or mastectomy, the accuracy of sentinel lymph node biopsy after excision is relevant to surgical management of DCIS. Most studies demonstrated that sentinel lymph node biopsy is feasible after breast-conserving surgery (BCS). Younger age, positive surgical margins, tumor size and grade, and comedo necrosis were consistently related to DCIS recurrence. DCIS outcomes after either mastectomy or BCS plus radiation therapy were superior to BCS alone. Tamoxifen treatment after DCIS diagnosis reduced risk of recurrent disease. Scientific questions deserving further investigation include the relationship between mammography use and DCIS incidence and whether imaging technologies and treatment guidelines can be modified to focus on lesions that are most likely to become clinically problematic.

Surgery and outcomes of ductal carcinoma in situ of the breast: a population-based study in Australia

We examined surgery and outcome in a population-based series of 2109 women newly diagnosed with ductal carcinoma in situ (DCIS) in 1995–2000 in New South Wales (NSW), Australia. The sole data source for the study was pathology records in the NSW Cancer Registry. Most DCIS was treated with breast-conserving surgery (BCS); use of breast conservation increased throughout the 6 years of the study. Women who were younger, had higher grade DCIS or had larger lesions were significantly and independently less likely to have BCS than other women. Eighteen percent of women had lymph nodes removed, most often with mastectomy. The NSW Cancer Registry does not collect information about radiotherapy. Based on cancer registrations alone, 97.7% of women were free of ipsilateral invasive cancer after three years; more women who had mastectomy were cancer-free (100%) than women who had breast-conserving surgery (97.2%; P = 0.05).