Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast.

1998 ◽  
Vol 16 (4) ◽  
pp. 1367-1373 ◽  
Author(s):  
M J Silverstein ◽  
M D Lagios ◽  
S Martino ◽  
B S Lewinsky ◽  
P H Craig ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma ◽  
Breast Cancer Mortality ◽  
Distant Disease ◽  
Breast Cancer Specific Mortality ◽  
Breast Preservation ◽  
Specific Mortality ◽  
Cancer Specific Mortality

PURPOSE To detail the outcome, in terms of local recurrence, local invasive recurrence, distant recurrence, and breast cancer mortality for patients previously treated for ductal carcinoma in situ (DCIS). PATIENTS AND METHODS Clinical, pathologic, and outcome data were collected prospectively for 707 patients with DCIS accrued from 1972 through June 1997. RESULTS There were 74 local recurrences; 39 were noninvasive (DCIS) and 35 were invasive. Fifty-one percent of patients with invasive recurrences presented with stage 1 disease; the remainder presented with more advanced disease. Invasive local recurrence after mastectomy was a rare event that occurred in 0.8% of patients. Invasive recurrence after breast preservation was more common and occurred in 7.4% of patients. The 8-year probability of breast cancer mortality after breast preservation was 2.1%, a number that is likely to increase with longer follow-up. The 8-year breast cancer-specific mortality and distant-disease probability for the subgroup of 74 patients with locally recurrent disease was 8.8% and 20.8%, respectively. If only the 35 invasive recurrences are considered as events, the 8-year breast cancer-specific mortality and distant-disease probability was 14.4% and 27.1%, respectively. CONCLUSION Invasive local recurrence after breast-preservation treatment for patients with DCIS is a serious event that converts patients with previous stage 0 disease to patients with disease that ranges from stage I to stage IV. These results, however, indicate that most DCIS patients with local recurrence can be salvaged.

scholarly journals Ductal Carcinoma In Situ of the Breast: Perspectives on Tumor Subtype and Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yufei Liu ◽  
Kangquan Shou ◽  
Juanjuan Li ◽  
Qi Wu ◽  
Yuchang Hu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Tumor Subtype ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Objective. To evaluate ductal carcinoma in situ (DCIS) characteristics and the effect of different treatment strategies. Patients and Methods. Using data with known hormone receptor (HoR) and human epidermal growth factor receptor 2 (HER2) status obtained by the Surveillance, Epidemiology, and End Results (SEER) program from 2010-2014, the study was conducted to investigate tumor subtype-specific differences in various characteristics, overall survival (OS), and breast cancer-specific mortality (BCSM). Results. A total of 3415 patients with DCIS were eligible. Compared with HoR+/HER- subgroup, patients with triple-negative (TN) and HoR-/HER+ were commonly higher in grade, larger in size, and tended to receive mastectomy (P<0.05). The multivariate analysis revealed that patients with TN were more likely to have a poorer OS and show a higher breast cancer-specific mortality compared with the HoR+/HER- subgroup (P<0.05). Multivariate analysis on the history of local treatment and surgery showed patients receiving breast-conserving surgery (BCS) plus radiotherapy (R) and BCS plus axillary lymph node dissection was likely to improve OS without affecting breast cancer-specific mortality (P<0.05). Conclusion. The results demonstrate that DCIS associated with TN subtype portends poor prognosis. Meanwhile, BCS plus R was a preferable option and resulted in survival rates better than those achieved with mastectomy, and SLNB should be considered as an appropriate assessment of axillary staging in patients with DCIS.

scholarly journals Patient Prognostic Score and Associations With Survival Improvement Offered by Radiotherapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study

2016 ◽  
Vol 34 (11) ◽  
pp. 1190-1196 ◽  
Author(s):  
Yasuaki Sagara ◽  
Rachel A. Freedman ◽  
Ines Vaz-Luis ◽  
Melissa Anne Mallory ◽  
Stephanie M. Wong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Local Recurrence ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Prognostic Score ◽  
Breast Cancer Mortality ◽  
Breast Conserving Surgery ◽  
Population Based

Purpose Radiotherapy (RT) after breast-conserving surgery (BCS) is a standard treatment option for the management of ductal carcinoma in situ (DCIS). We sought to determine the survival benefit of RT after BCS on the basis of risk factors for local recurrence. Patients and Methods A retrospective longitudinal cohort study was performed to identify patients with DCIS diagnosed between 1988 and 2007 and treated with BCS by using SEER data. Patients were divided into the following two groups: BCS+RT (RT group) and BCS alone (non-RT group). We used a patient prognostic scoring model to stratify patients on the basis of risk of local recurrence. We performed a Cox proportional hazards model with propensity score weighting to evaluate breast cancer mortality between the two groups. Results We identified 32,144 eligible patients with DCIS, 20,329 (63%) in the RT group and 11,815 (37%) in the non-RT group. Overall, 304 breast cancer–specific deaths occurred over a median follow-up of 96 months, with a cumulative incidence of breast cancer mortality at 10 years in the weighted cohorts of 1.8% (RT group) and 2.1% (non-RT group; hazard ratio, 0.73; 95% CI, 0.62 to 0.88). Significant improvements in survival in the RT group compared with the non-RT group were only observed in patients with higher nuclear grade, younger age, and larger tumor size. The magnitude of the survival difference with RT was significantly correlated with prognostic score (P < .001). Conclusion In this population-based study, the patient prognostic score for DCIS is associated with the magnitude of improvement in survival offered by RT after BCS, suggesting that decisions for RT could be tailored on the basis of patient factors, tumor biology, and the prognostic score.

Beta Blockers and Breast Cancer Mortality: A Population- Based Study

2011 ◽  
Vol 29 (19) ◽  
pp. 2635-2644 ◽  
Author(s):  
Thomas I. Barron ◽  
Roisin M. Connolly ◽  
Linda Sharp ◽  
Kathleen Bennett ◽  
Kala Visvanathan
Keyword(s):  
Breast Cancer ◽  
Beta Blocker ◽  
Breast Tumor ◽  
Breast Cancer Mortality ◽  
Population Based ◽  
Cumulative Probability ◽  
Adrenergic Signaling ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose Preclinical studies have demonstrated that antagonism of β2-adrenergic signaling inhibits several pathways necessary for breast tumor progression and metastasis. A series of population-based observational studies were conducted to examine associations between beta blocker use and breast tumor characteristics at diagnosis or breast cancer–specific mortality. Patients and Methods Linked national cancer registry and prescription dispensing data were used to identify women with a diagnosis of stage I to IV invasive breast cancer between January 1, 2001, and December 31, 2006. Women taking propranolol (β1/β2 antagonist; n = 70) or atenolol (β1 antagonist; n = 525), in the year before breast cancer diagnosis were matched (1:2) to women not taking a beta blocker (n = 4,738). Associations between use of propranolol or atenolol and risk of local tumor invasion at diagnosis (T4 tumor), nodal or metastatic involvement at diagnosis (N2/N3/M1 tumor), and time to breast cancer–specific mortality were assessed. Results Propranolol users were significantly less likely to present with a T4 (odds ratio [OR], 0.24, 95% CI, 0.07 to 0.85) or N2/N3/M1 (OR, 0.20; 95% CI, 0.04 to 0.88) tumor compared with matched nonusers. The cumulative probability of breast cancer–specific mortality was significantly lower for propranolol users compared with matched nonusers (hazard ratio, 0.19; 95% CI, 0.06 to 0.60). There was no difference in T4 or N2/N3/M1 tumor incidence or breast cancer–specific mortality between atenolol users and matched nonusers. Conclusion The results provide evidence in humans to support preclinical observations suggesting that inhibiting the β2-adrenergic signaling pathway can reduce breast cancer progression and mortality.

scholarly journals A medicare-based comparative mortality analysis of active surveillance in older women with DCIS

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Igor Akushevich ◽  
Arseniy P. Yashkin ◽  
Rachel A. Greenup ◽  
E. Shelley Hwang
Keyword(s):  
Breast Cancer ◽  
Active Surveillance ◽  
Ductal Carcinoma ◽  
Age Groups ◽  
Delayed Treatment ◽  
Breast Cancer Specific Mortality ◽  
Treatment Type ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Immediate Surgery

Abstract Over 97% of individuals diagnosed with ductal carcinoma in situ (DCIS) will choose to receive guideline concordant care (GCC), which was originally designed to treat invasive cancers and is associated with treatment related morbidity. An alternative to GCC is active surveillance (AS) where therapy is delayed until medically necessary. Differences in mortality risk between the two approaches in women age 65+ are analyzed in this study. SEER and Medicare information on treatment during the first year after diagnosis was used to identify three cohorts based on treatment type and timing: GCC (N = 21,772; immediate consent for treatment), AS1 (N = 431; delayed treatment within 365 days), and AS2 (N = 205; no treatment/ongoing AS). A propensity score-based approach provided pseudorandomization between GCC and AS groups and survival was then compared. Strong influence of comorbidities on the treatment received was observed for all age-groups, with the greatest burden observed in the AS2 group. All-cause and breast-cancer-specific mortality hazard ratios (HR) for AS1 were not statistically different from the GCC group; AS2 was associated with notably higher risk for both all-cause (HR:3.54; CI:3.29, 3.82) and breast-cancer-specific (HR:10.73; CI:8.63,13.35) mortality. Cumulative mortality was substantially higher from other causes than from breast cancer, regardless of treatment group. Women managed with AS for DCIS had higher all-cause and breast-cancer-specific mortality. This effect declined after accounting for baseline comorbidities. Delays of up to 12 months in initiation of GCC did not underperform immediate surgery.

scholarly journals Breast Cancer in Jamaica: Trends From 2010 to 2014—Is Mortality Increasing?

2020 ◽  
pp. 837-843
Author(s):  
Sonya Reid ◽  
Kayon Donaldson-Davis ◽  
Douladel Willie-Tyndale ◽  
Camelia Thompson ◽  
Gilian Wharfe ◽  
...  
Keyword(s):  
Public Health ◽  
Breast Cancer ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Mortality Rates ◽  
Breast Cancer Specific Mortality ◽  
Jamaican Women ◽  
Specific Mortality ◽  
Cancer Specific Mortality

PURPOSE This study sought to provide a detailed analysis of breast cancer–specific mortality in Jamaica on the basis of reported deaths between 2010 and 2014. METHODS A cross-sectional study was done to analyze breast cancer–specific mortality data from the Registrar General’s Department, the statutory body responsible for registering all deaths across Jamaica. RESULTS A total of 1,634 breast cancer–related deaths were documented among Jamaican women between 2010 and 2014, which accounted for 24% of all female cancer deaths. The age-standardized breast cancer mortality rate increased from 21.8 per 100,000 in 2010 to 28 per 100,000 in 2014 for the total female population. The overall difference in breast cancer mortality rates between the 2014 and 2010 rates was not statistically significant ( P = .114). Analysis of the year-by-year trend reflected by the annual percentage of change did show, however, a statistically significant increasing trend in breast cancer mortality ( P = .028). Mortality rates varied by age, with statistically significant annual increases observed in the 35-44–, 65-74–, and ≥ 75-year age groups ( P = .04, .03, and .01, respectively). CONCLUSION Breast cancer remains the leading cause of cancer-related death among Jamaican women. Despite global advances in breast cancer screening and management, breast cancer remains a major public health challenge and represents a public health priority in Jamaica. The increasing breast cancer–specific mortality in Jamaica over the 5-year period contrasts with decreasing mortality rates among US women with breast cancer. This study highlights the critical need to address the implementation of a national organized breast cancer screening program in Jamaica and to focus future research efforts on the biology of breast cancer, especially among young Jamaican women.

scholarly journals Mortality After Invasive Second Breast Cancers Following Prior Radiotherapy for DCIS

2019 ◽  
Vol 17 (11) ◽  
pp. 1367-1371 ◽  
Author(s):  
Puyao C. Li ◽  
Zilu Zhang ◽  
Angel M. Cronin ◽  
Rinaa S. Punglia
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Interaction Analysis ◽  
Receptor Expression ◽  
Breast Cancer Specific Mortality ◽  
Increased Risk ◽  
Significant Difference ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
The Impact

Background: Women with a history of ductal carcinoma in situ (DCIS) are at increased risk for developing a second breast cancer (SBC). A prior meta-analysis of randomized studies of radiotherapy (RT) for DCIS has shown a trend toward increased breast cancer–specific mortality after SBC, but it did not have the power needed to detect a significant difference, due to a limited number of recurrences. This study sought to evaluate the impact of RT for DCIS on mortality after SBC in a larger cohort. Patients and Methods: Using the SEER database, 3,407 patients were identified who received breast-conserving therapy with or without RT for primary DCIS in 2000 through 2013 and subsequently developed a stage I–III invasive SBC within the same time period. Fine-Gray competing risk models were used to study the association between receipt of RT and mortality after SBC. Results: Prior RT was found to be associated with higher rates of breast cancer–specific mortality (hazard ratio [HR], 1.70; 95% CI, 1.18–2.45; P=.005), even after controlling for cancer stage. Interaction analysis suggested that this risk trended higher in patients with ipsilateral versus contralateral SBC (HR, 2.07 vs 1.26; P=.16). Furthermore, compared with patients who developed contralateral SBC, those with ipsilateral SBC were younger (P<.001) and more often lacked estrogen receptor expression (P<.001). Conclusions: Patients who previously received RT for DCIS had higher mortality after developing an invasive SBC than those who did not receive RT. This finding may have implications for initial treatment decisions in the management of DCIS.

Sign in / Sign up

Export Citation Format

Share Document