Cost Effectiveness of the Oncotype DX DCIS Score for Guiding Treatment of Patients With Ductal Carcinoma In Situ

2016 ◽  
Vol 34 (33) ◽  
pp. 3963-3968 ◽  
Author(s):  
Ann C. Raldow ◽  
David Sher ◽  
Aileen B. Chen ◽  
Abram Recht ◽  
Rinaa S. Punglia
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Cost Effective ◽  
Risk Scores ◽  
High Grade ◽  
The Cost

Purpose The Oncotype DX DCIS Score short form (DCIS Score) estimates the risk of an ipsilateral breast event (IBE) in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery without adjuvant radiation therapy (RT). We determined the cost effectiveness of strategies using this test. Materials and Methods We developed a Markov model simulating 10-year outcomes for 60-year-old women eligible for the Eastern Cooperative Oncology Group E5194 study (cohort 1: low/intermediate-grade DCIS, ≤ 2.5 cm; cohort 2: high-grade DCIS, ≤ 1 cm) with each of five strategies: (1) no testing, no RT; (2) no testing, RT only for cohort 2; (3) no RT for low-grade DCIS, test for intermediate- and high-grade DCIS, RT for intermediate- or high-risk scores; (4) test all, RT for intermediate- or high-risk scores; and (5) no testing, RT for all. We used utilities and costs extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios and examined the number of women needed to irradiate per IBE prevented. Results No strategy using the DCIS Score was cost effective. The most cost-effective strategy (RT for none or RT for all) was sensitive to small differences between the utilities of receiving or not receiving RT and remaining without recurrence. The numbers needed to irradiate per IBE prevented were 10.5, 9.1, 7.5, and 13.1 for strategies 2 to 5, respectively, relative to strategy 1. Conclusion Strategies using the DCIS Score lowered the proportion of women undergoing RT per IBE prevented. However, no strategy incorporating the DCIS Score was cost effective. The cost effectiveness of RT was exquisitely utility sensitive, highlighting the importance of engaging patient preferences in this decision. Physicians should discuss trade-offs associated with omitting or adding adjuvant RT with each patient to maximize quality-of-life outcomes.

scholarly journals Cost Effectiveness of DCISionRT for Guiding Treatment of Ductal Carcinoma in Situ

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Ann C Raldow ◽  
David Sher ◽  
Aileen B Chen ◽  
Rinaa S Punglia
Keyword(s):  
Cost Effectiveness ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Cost Effective ◽  
Base Case ◽  
Adjuvant Radiation ◽  
Case Scenario ◽  
The Cost

Abstract The DCISionRT test estimates the risk of an ipsilateral breast event (IBE) in patients with ductal carcinoma in situ (DCIS) as well as the benefit of adjuvant radiation therapy (RT). We determined the cost-effectiveness of DCISionRT using a Markov model simulating 10-year outcomes for 60-year-old women with DCIS based on nonrandomized data. Three strategies were compared: no testing, no RT (strategy 1); test all, RT for elevated risk only (strategy 2); and no testing, RT for all (strategy 3). We used utilities and costs from the literature and Medicare claims to determine incremental cost-effectiveness ratios and examined the number of women irradiated per IBE prevented. In the base-case scenario, strategy 1 was the cost-effective strategy. Strategy 2 was cost-effective compared with strategy 3 when the cost of DCISionRT was less than $4588. The number irradiated per IBE prevented were 8.37 and 15.46 for strategies 2 and 3, respectively, relative to strategy 1.

Cost-Effectiveness of Adjuvant Treatment for Ductal Carcinoma In Situ

2021 ◽  
pp. JCO.21.00831
Author(s):  
Apar Gupta ◽  
Sachin R. Jhawar ◽  
Mutlay Sayan ◽  
Zeinab A. Yehia ◽  
Bruce G. Haffty ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Standard Risk ◽  
Quality Adjusted Life ◽  
Good Risk

PURPOSE Ductal carcinoma in situ (DCIS) accounts for 20% of breast cancer cases in the United States and is potentially overtreated, leading to high expenditures and low-value care. We conducted a cost-effectiveness analysis evaluating all adjuvant treatment strategies for DCIS. METHODS A Markov model was created with six competing treatment strategies: observation, tamoxifen (TAM) alone, aromatase inhibitor (AI) alone, radiation treatment (RT) alone, RT + TAM, and RT + AI. Baseline recurrence rates were modeled using the NSABP B17 and RTOG 9804 trials for standard-risk and good-risk DCIS, respectively. Relative risk reductions and adverse event rates for each treatment strategy were derived from meta-analyses of large randomized trials. We used a willingness-to-pay threshold of $100,000 in US dollars/quality-adjusted life-year and a lifetime horizon for two cohorts of women, age 40 and 60 years. Comprehensive sensitivity analyses evaluated the robustness of base-case results. RESULTS RT alone was cost-effective for patients with standard-risk DCIS, and observation was cost-effective for patients with good-risk DCIS, across both age groups. Strategies including TAM or AI resulted in fewer quality-adjusted life-years than observation, because of the prolonged decrement in quality of life outweighing the modest benefit in ipsilateral risk reduction. In sensitivity analysis, RT alone was cost-effective for age 40, good-risk patients when ipsilateral risk reduction matched that of the RTOG 9804 trial, there was minimal increased risk of contralateral breast secondary malignancy, or there was strong patient willingness to pursue RT. CONCLUSION Our findings suggest that cost-effective and clinically optimal treatment strategies are RT alone for standard-risk DCIS and observation for good-risk DCIS, with personalization on the basis of patient age and preference for RT. Hormonal therapy is likely suboptimal for most patients with DCIS.

When Is Sentinel Node Biopsy Indicated in High-Risk Ductal Carcinoma in situ? Four Hundred Sixty-Eight Cases from Three Institutions

Breast Care ◽  
2021 ◽  
pp. 1-7
Author(s):  
Tomás Cortadellas ◽  
Paula Argacha ◽  
Juan Acosta ◽  
Judith Jurado ◽  
Ricardo Peiró ◽  
...  
Keyword(s):  
High Risk ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Mass Effect ◽  
High Grade ◽  
Palpable Mass ◽  
Surgical Specimen ◽  
Node Biopsy

<b><i>Introduction:</i></b> Sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) is not indicated. However, in certain cases (size &#x3e;3 cm, high grade, mass effect on mammography, or palpable mass), it may be possible to find incidental invasive carcinoma (IC) that requires an SLNB. We studied the correlation of the aforesaid factors with the probability of finding IC in the surgical specimen. <b><i>Methods:</i></b> Data was collected from 3 different institutions between 2010 and 2016, recording characteristics such as, but not limited to: high grade, size &#x3e;3 cm, mass effect on mammography, and palpable mass. <b><i>Results:</i></b> On the whole, 468 “high-risk” DCIS cases were identified, 139 (29%) of which had IC. When the DCIS was high grade or the size was &#x3e;3 cm, there was no significant difference in the probability of finding IC in the surgical specimen (OR = 1.13; 95% CI 0.84–1.51; OR = 1.2; 95% CI 0.85–1.40). Nevertheless, when a high grade and size (&#x3e;3 cm) were combined, IC was more likely to exist (72.7 vs. 27.3%; <i>p</i> = 0.001). In addition, mass effect and palpation were independently associated with a significantly greater degree of IC (OR = 12.76; 95% CI 6.93–23.52). <b><i>Conclusions:</i></b> The results suggest that high-grade DCIS or DCIS with a size &#x3e;3 cm, independently, does not require SLNB. Nonetheless, in the event that both factors are found in the same case, SLNB may be indicated. Additionally, SLNB is advisable for DCIS cases that are palpable or show a mass effect on mammography.

scholarly journals Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

2021 ◽  
Vol 186 (3) ◽  
pp. 617-624
Author(s):  
Kate R. Pawloski ◽  
Audree B. Tadros ◽  
Varadan Sevilimedu ◽  
Ashley Newman ◽  
Lori Gentile ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Advanced Disease ◽  
Breast Conserving Surgery ◽  
Risk Profile ◽  
High Grade ◽  
Group A ◽  
First Recurrence

Abstract Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.

Immunostaining of ∆Np63 (using the p40 antibody) is equal to that of p63 and CK5/6 in high-grade ductal carcinoma in situ of the breast

2015 ◽  
Vol 467 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Verena Sailer ◽  
Christine Lüders ◽  
Walther Kuhn ◽  
Volker Pelzer ◽  
Glen Kristiansen
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
High Grade

scholarly journals High-grade ductal carcinoma in-situ detected by microcalcification within borderline phyllodes tumour: A report of a case and literature review

2021 ◽  
Author(s):  
Wing Nam Yuen ◽  
Joshua Jing Xi Li ◽  
Man Yi Chan ◽  
Gary M Tse
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Management Plan ◽  
High Grade ◽  
Total Mastectomy ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Abstract BackgroundPhyllodes tumour is a rare biphasic neoplasm of the breast that mostly affects middle aged women. Ductal carcinoma in-situ and microcalcifications occurring within phyllodes tumours are documented but are rare findings. Primary surgical excision with adjuvant therapies remains the mainstay of treatment.Case presentationWe report a case of a 42-year-old woman with high-grade ductal carcinoma in-situ within a borderline phyllodes tumour. Radiologically, clumps of microcalcification were detected within the lesion. Local excision followed by total mastectomy with axillary dissection was then performed. No tumour recurrence was detected up to a period of 8 years.ConclusionPresence of microcalcifications within a phyllodes tumour should alert clinicians and pathologists of possible coexisting carcinoma components. Stromal and epithelial components of these lesions should be evaluated separately when formulating a management plan.

scholarly journals Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings

Breast Care ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 386-391
Author(s):  
Benedict Krischer ◽  
Serafino Forte ◽  
Gad Singer ◽  
Rahel A. Kubik-Huch ◽  
Cornelia Leo
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Significant Proportion ◽  
Invasive Cancer ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Surgical Specimen

Purpose: The question of overtreatment of ductal carcinoma in situ (DCIS) was raised because a significant proportion of especially low-grade DCIS lesions never progress to invasive cancer. The rationale for the present study was to analyze the value of stereotactic vacuum-assisted biopsy (VAB) for complete removal of DCIS, focusing on the relationship between the absence of residual microcalcifications after stereotactic VAB and the histopathological diagnosis of the definitive surgical specimen. Patients and Methods: Data of 58 consecutive patients diagnosed with DCIS by stereotactic VAB in a single breast center between 2012 and 2017 were analyzed. Patient records from the hospital information system were retrieved, and mammogram reports and images as well as histopathology reports were evaluated. The extent of microcalcifications before and after biopsy as well as the occurrence of DCIS in biopsy and definitive surgical specimens were analyzed and correlated. Results: There was no correlation between the absence of residual microcalcifications in the post-biopsy mammogram and the absence of residual DCIS in the final surgical specimen (p = 0.085). Upstaging to invasive cancer was recorded in 4 cases (13%) but occurred only in the group that had high-grade DCIS on biopsy. Low-grade DCIS was never upgraded to high-grade DCIS in the definitive specimen. Conclusions: The radiological absence of microcalcifications after stereotactic biopsy does not rule out residual DCIS in the final surgical specimen. Since upstaging to invasive cancer is seen in a substantial proportion of high-grade DCIS, the surgical excision of high-grade DCIS should remain the treatment of choice.

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