Skip to main content

Advertisement

SpringerLink
Log in

Predictors of Local Recurrence in a Population-Based Cohort of Women with Ductal Carcinoma In Situ Treated with Breast Conserving Surgery Alone

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To identify prognostic indicators of local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conserving surgery (BCS) alone.

Methods

A retrospective study was conducted of all women with pure DCIS, diagnosed 1985–1999, referred for tertiary oncologic opinion in British Columbia, treated with BCS without adjuvant radiotherapy. Kaplan–Meier local control (LC) and breast cancer specific survival (BCSS) estimates for the entire group were plotted. Stratified analyses identified subgroups with high Kaplan–Meier 10-year LR. Cox multivariate modeling was used to assess predictors of LR. Kaplan–Meier BCSS rates were compared between two cohorts: those who experienced LR and those who did not have LR.

Results

A total of 460 women comprised the study cohort. Median follow-up was 9.4 years. The 15-year LC and BCSS rates were 82% and 97%, respectively. Stratified analyses of LR identified comedo histology, high nuclear grade, tumor size >4 cm or indeterminate size, and positive margins to be associated with significantly higher LR risk, with 10-year LR risks approximating 15–30%. The 10-year BCSS rates for the LR group were 94% compared with 99% for the NoLR group. On Cox regression modeling, high nuclear grade, the presence of comedocarcinoma, and positive margins were significant factors for higher risk of LR.

Conclusions

Women with DCIS treated with BCS alone had higher LR risk, and those with a LR were more likely to die of breast cancer. Optimal local treatment is mandatory to minimize the risk of breast cancer death for women with this curable disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C. Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA. 1996;275:913–8.

    Article  CAS  PubMed  Google Scholar 

  2. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160:953–8.

    Article  CAS  PubMed  Google Scholar 

  3. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS, Spittle M, et al. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet. 2003;362:95–102.

    Article  PubMed  Google Scholar 

  4. Viani GA, Stefano EJ, Afonso SL, De Fendi LI, Soares FV, Leon PG, et al. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials. Radiat Oncol. 2007;2:28.

    Article  PubMed  Google Scholar 

  5. Bijker N, Peterse JL, Fentiman IS, Julien JP, Hart AA, Avril A, et al. Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS. Br J Cancer. 2002;87:615–20.

    Article  CAS  PubMed  Google Scholar 

  6. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N. Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the national surgical adjuvant breast and bowel project experience. Semin Oncol. 2001;28:400–18.

    Article  CAS  PubMed  Google Scholar 

  7. Holmberg L, Garmo H, Granstrand B, Ringberg A, Arnesson LG, Sandelin K, et al. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol. 2008;26:1247–52.

    Article  PubMed  Google Scholar 

  8. Olivotto I, Levine M, Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: The management of ductal carcinoma in situ (summary of the 2001 update). CMAJ. 2001;165:912–3.

    CAS  PubMed  Google Scholar 

  9. American College of Radiology. Practice guideline for the management of ductal carcinoma in situ of the breast (DCIS). J Am Coll Surg. 2007;205:145–61.

    Article  Google Scholar 

  10. Boyages J, Delaney G, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer. 1999;85:616–28.

    Article  CAS  PubMed  Google Scholar 

  11. Schouten van der Velden AP, van Vugt R, Van Dijck JA, Leer JW, Wobbes T. Local recurrences after different treatment strategies for ductal carcinoma in situ of the breast: a population-based study in the east netherlands. Int J Radiat Oncol Biol Phys. 2007;69:703–10.

    Article  PubMed  Google Scholar 

  12. Smith BD, Haffty BG, Buchholz TA, Smith GL, Galusha DH, Bekelman JE, et al. Effectiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst. 2006;98:1302–10.

    Article  PubMed  Google Scholar 

  13. Kestin LL, Goldstein NS, Martinez AA, Rebner M, Balasubramaniam M, Frazier RC, et al. Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy: patterns of failure and 10-year results. Ann Surg. 2000;231:235–45.

    Article  CAS  PubMed  Google Scholar 

  14. Wong JS, Kaelin CM, Troyan SL, Gadd MA, Gelman R, Lester SC, et al. Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol. 2006;24:1031–6.

    Article  PubMed  Google Scholar 

  15. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77:2267–74.

    Article  CAS  PubMed  Google Scholar 

  16. Silverstein MJ. The University of Southern California/Van nuys prognostic index for ductal carcinoma in situ of the breast. Am J Surg. 2003;186:337–43.

    Article  PubMed  Google Scholar 

  17. British Columbia Cancer Agency. In: Rheaume D, editor. Cancer treatment policies. 5th ed. Vancouver: British Columbia Cancer Agency, 1995.

  18. British Columbia Cancer Agency. Radiotherapy techniques. 1995 (in press).

  19. Cancer Control Agency of British Columbia. Cancer treatment policies. 3rd ed. Vancouver: Cancer Control Agency of British Columbia, 1988.

    Google Scholar 

  20. Emdin SO, Granstrand B, Ringberg A, Sandelin K, Arnesson LG, Nordgren H, et al. SweDCIS: radiotherapy after sector resection for ductal carcinoma in situ of the breast: results of a randomised trial in a population offered mammography screening. Acta Oncol. 2006;45:536–43.

    Article  PubMed  Google Scholar 

  21. Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328:1581–6.

    Article  CAS  PubMed  Google Scholar 

  22. Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from national surgical adjuvant breast and bowel project B-17. J Clin Oncol. 1998;16:441–52.

    CAS  PubMed  Google Scholar 

  23. Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E. Pathologic findings from the national surgical adjuvant breast project (NSABP) protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The national surgical adjuvant breast and bowel project collaborating investigators. Cancer. 1995;75:1310–9.

    Article  CAS  PubMed  Google Scholar 

  24. Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC breast cancer cooperative group and EORTC radiotherapy group. Lancet. 2000;355:528–33.

    Article  CAS  PubMed  Google Scholar 

  25. Adepoju LJ, Symmans WF, Babiera GV, Singletary SE, Arun B, Sneige N, et al. Impact of concurrent proliferative high-risk lesions on the risk of ipsilateral breast carcinoma recurrence and contralateral breast carcinoma development in patients with ductal carcinoma in situ treated with breast-conserving therapy. Cancer. 2006;106:42–50.

    Article  PubMed  Google Scholar 

  26. Kerlikowske K, Molinaro A, Cha I, Ljung BM, Ernster VL, Stewart K, et al. Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy. J Natl Cancer Inst. 2003;95:1692–702.

    PubMed  Google Scholar 

  27. Rodrigues N, Carter D, Dillon D, Parisot N, Choi DH, Haffty BG. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2002;54:1331–5.

    Article  PubMed  Google Scholar 

  28. Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med. 1999;340:1455–61.

    Article  CAS  PubMed  Google Scholar 

  29. Vargas C, Kestin L, Go N, Krauss D, Chen P, Goldstein N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys. 2005;63:1514–21.

    Article  PubMed  Google Scholar 

  30. Ben-David MA, Sturtz DE, Griffith KA, Douglas KR, Hayman JA, Lichter AS, et al. Long-term results of conservative surgery and radiotherapy for ductal carcinoma in situ using lung density correction: the University of Michigan experience. Breast J. 2007;13:392–400.

    Article  PubMed  Google Scholar 

  31. Meijnen P, Oldenburg HS, Peterse JL, Bartelink H, Rutgers EJ. Clinical outcome after selective treatment of patients diagnosed with ductal carcinoma in situ of the breast. Ann Surg Oncol. 2008;15:235–43.

    Article  PubMed  Google Scholar 

  32. Solin LJ, Fourquet A, Vicini FA, Haffty B, Taylor M, McCormick B, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer. 2001;91:1090–7.

    Article  CAS  PubMed  Google Scholar 

  33. Solin LJ, Fourquet A, Vicini FA, Taylor M, Haffty B, Strom EA, et al. Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ. Eur J Cancer. 2005;41:1715–23.

    Article  PubMed  Google Scholar 

  34. Solin LJ, Fourquet A, Vicini FA, Taylor M, Olivotto IA, Haffty B, et al. Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer. 2005;103:1137–46.

    Article  PubMed  Google Scholar 

  35. Omlin A, Amichetti M, Azria D, Cole BF, Fourneret P, Poortmans P, et al. Boost radiotherapy in young women with ductal carcinoma in situ: a multicentre, retrospective study of the rare cancer network. Lancet Oncol. 2006;7:652–6.

    Article  PubMed  Google Scholar 

  36. Solin LJ, Fourquet A, Vicini FA, Haffty B, Taylor M, McCormick B, et al. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status. Int J Radiat Oncol Biol Phys. 2001;50:991–1002.

    Article  CAS  PubMed  Google Scholar 

  37. Solin LJ, Kurtz J, Fourquet A, Amalric R, Recht A, Bornstein BA, et al. Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol. 1996;14:754–63.

    CAS  PubMed  Google Scholar 

  38. Romero L, Klein L, Ye W, Holmes D, Soni R, Silberman H, et al. Outcome after invasive recurrence in patients with ductal carcinoma in situ of the breast. Am J Surg. 2004;188:371–6.

    Article  PubMed  Google Scholar 

  39. Cuzick J, Sestak I, Pinder S, Ellis I, Hackshaw A, Bundred N, et al. Beneficial effect of tamoxifen for women with DCIS: long-term results from the UK/ANZ DCIS trial in women with locally excised DCIS. Cancer Res. 2009;69:34.

    Article  Google Scholar 

  40. Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, et al. Tamoxifen in treatment of intraductal breast cancer: national surgical adjuvant breast and bowel project B-24 randomised controlled trial. Lancet. 1999;353:1993–2000.

    Article  CAS  PubMed  Google Scholar 

  41. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors would like to acknowledge funding support for this work through operating grants from the Canadian Breast Cancer Foundation, BC/Yukon Chapter, and Canadian Breast Cancer Research Alliance. The authors thank Caroline Walter for assistance with manuscript preparation.

Conflicts of Interest

The authors declare no conflicts of interest related to this work.

Author information

Authors and Affiliations

  1. Radiation Therapy Program, BC Cancer Agency—Vancouver Island Centre, Victoria, BC, Canada

    Elaine S. Wai BSc, MD, SM, FRCPC, Pauline T. Truong MD, FRCPC & Ivo A. Olivotto BSc, MD, FRCPC

  2. Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Elaine S. Wai BSc, MD, SM, FRCPC, Pauline T. Truong MD, FRCPC & Ivo A. Olivotto BSc, MD, FRCPC

  3. Breast Cancer Outcomes Unit, BC Cancer Agency, Victoria, BC, Canada

    Elaine S. Wai BSc, MD, SM, FRCPC, Cheryl S. Alexander CHIM, Pauline T. Truong MD, FRCPC & Ivo A. Olivotto BSc, MD, FRCPC

  4. Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada

    Mary L. Lesperance BA, BSc, MMath, PhD, PStat & Jennifer Lindquist BSc

  5. Department of Dermatology, University of British Columbia, Vancouver, BC, Canada

    Patrizia Moccia BSc, MD

  6. Memorial University of Newfoundland, St. John’s, NL, Canada

    Matthew Culp BSc, MD

Authors
  1. Elaine S. Wai BSc, MD, SM, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary L. Lesperance BA, BSc, MMath, PhD, PStat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheryl S. Alexander CHIM
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pauline T. Truong MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrizia Moccia BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew Culp BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jennifer Lindquist BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ivo A. Olivotto BSc, MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elaine S. Wai BSc, MD, SM, FRCPC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wai, E.S., Lesperance, M.L., Alexander, C.S. et al. Predictors of Local Recurrence in a Population-Based Cohort of Women with Ductal Carcinoma In Situ Treated with Breast Conserving Surgery Alone. Ann Surg Oncol 18, 119–124 (2011). https://doi.org/10.1245/s10434-010-1214-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1214-x

Keywords

Search

Navigation