Incidental atypical hyperplasia/LCIS in mammoplasty specimens and subsequent risk of breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1561-1561
Author(s):  
Francisco Acevedo ◽  
Victor Diego Armengol ◽  
Zhengyi Deng ◽  
Rong Tang ◽  
Suzanne Coopey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Reduction Mammoplasty ◽  
Atypical Hyperplasia ◽  
Abnormal Mammogram ◽  
Subsequent Risk

1561 Background: Proliferative breast lesions with atypia (atypical hyperplasia and lobular carcinoma in-situ (LCIS)) increase the risk of breast cancer (BC). Most cases are diagnosed in the context of an abnormal mammogram. Little is known about BC risk for patients with these lesions who are asymptomatic. Mammoplasty specimens allow us to study breast tissue in asymptomatic healthy women. We previously published the rate of atypia in the largest reported mammoplasty cohort. The aim of this study is to examine the risk of BC in the atypia cohort. Methods: Breast pathology reports were retrospectively reviewed for evidence of atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) or LCIS in bilateral reduction mammoplasty specimens from five institutions within a single healthcare system between 1990 to 2017. Patients with prior or concurrent BC or prior atypia were excluded. Data was extracted from electronic medical records using natural language processing and manual review to assess subsequent risk of BC. Results: From our mammoplasty cohort of 4771 patients, 295 patients were found to have atypia (6.2%) at baseline. 40 of these patients were lost to follow-up and excluded from the study. For the remaining 255 patients, 13 had severe ADH bordering on ductal carcinoma in situ, 52 had LCIS, 119 had ALH, and 71 had ADH at baseline. The median age at baseline was 52.1 (range 17.9 – 74.3). With a median follow-up of 7.7 years, of the 255 patients 9 patients developed BC (8 invasive carcinomas, 1 ductal carcinoma in situ). 81.3% of the cohort did not receive chemoprevention. Only one patient out of the nine who developed BC received chemoprevention. The risk of developing BC among women with atypia at baseline was 0.5%, 2.9% and 4.1%, at 3, 5 and 10 years respectively. Conclusions: Patients with asymptomatic atypias found in reduction mammoplasty specimens appear to be at lower risk of developing BC than those diagnosed with atypia in the context of an abnormal mammogram. These results may provide guidance on how to manage this group of patients related to future screening and/or chemoprevention.

scholarly journals Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24

2012 ◽  
Vol 30 (12) ◽  
pp. 1268-1273 ◽  
Author(s):  
D. Craig Allred ◽  
Stewart J. Anderson ◽  
Soonmyung Paik ◽  
D. Lawrence Wickerham ◽  
Iris D. Nagtegaal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Significant Benefit ◽  
Adjuvant Tamoxifen ◽  
Receptor Status ◽  
Er Positive

Purpose The NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen. Patients and Methods Estrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n = 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n = 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years). Results ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P < .001) and overall follow-up (HR, 0.60; P = .003), which remained significant in multivariable analysis (overall HR, 0.64; P = .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone. Conclusion Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.

Effect of Radiotherapy After Breast-Conserving Surgery for Ductal Carcinoma in Situ: 20 Years Follow-Up in the Randomized SweDCIS Trial

2014 ◽  
Vol 32 (32) ◽  
pp. 3613-3618 ◽  
Author(s):  
Fredrik Wärnberg ◽  
Hans Garmo ◽  
Stefan Emdin ◽  
Veronica Hedberg ◽  
Linda Adwall ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Reduction ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Breast Conserving Surgery

Purpose Four randomized studies show that adjuvant radiotherapy (RT) lowers the risk of subsequent ipsilateral breast events (IBEs) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) by approximately 50% after 10 to 15 years. We present 20 years of follow-up data for the SweDCIS trial. Patients and Methods Between 1987 and 1999 1,046 women were randomly assigned to RT or not after BCS for primary DCIS. Results up to 2005 have been published, and we now add another 7 years of follow-up. All breast cancer events and causes of death were registered. Results There were 129 in situ and 129 invasive IBEs. Absolute risk reduction in the RT arm was 12.0% at 20 years (95% CI, 6.5 to 17.7), with a relative risk reduction of 37.5%. Absolute reduction was 10.0% (95% CI, 6.0 to 14.0) for in situ and 2.0% (95% CI, −3.0 to 7.0) for invasive IBEs. There was a nonstatistically significantly increased number of contralateral events in the RT arm (67 v 48 events; hazard ratio, 1.38; 95% CI, 0.95 to 2.00). Breast cancer–specific death and overall survival were not influenced. Younger women experienced a relatively higher risk of invasive IBE and lower effect of RT. The hazard over time looked different for in situ and invasive IBEs. Conclusion Use of adjuvant RT is supported by 20-year follow-up. Modest protection against invasive recurrences and a possible increase in contralateral cancers still call for a need to find groups of patients for whom RT could be avoided or mastectomy with breast reconstruction is indicated.

Abstract 11025: Cardiovascular Disease Mortality Among Black and White Women With Ductal Carcinoma in Situ of the Breast

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Amy Berkman ◽  
Bernard Cole ◽  
Philip A Ades ◽  
Samantha Dickey ◽  
Stephen T Higgins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cardiovascular Disease ◽  
Black Women ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
White Women ◽  
Ductal Carcinoma ◽  
Cvd Mortality

Background: Ductal carcinoma in situ (DCIS) of the breast represents 15-20% of new breast cancer diagnoses in the United States annually and the incidence has been escalating since the 1970s. Long-term competing risks of cardiovascular disease (CVD) mortality, as well as racial differences in outcomes among US women with DCIS are unknown. Methods: Case data from the years 1978-2010 was abstracted using SEER*Stat software available through the National Cancer Institute from the 2010 SEER (Surveillance, Epidemiology and End Reports) registries. We evaluated CVD, breast cancer, and all-cause mortality using cumulative incidence rates and hazard ratios (HRs). Results: A total of 12,173 deaths were observed over a median follow up time of 9.2 years with 33% of deaths due to CVD and 8% due to breast cancer. The cumulative incidences of CVD death at 5, 10, and 20 years of follow up were 2.0% (95% CI 1.8-2.1), 5.1% (CI 4.9-5.3), and 13.2% (CI 12.8-13.7), respectively. The highest incidence of CVD mortality were found in women diagnosed with DCIS between 1978-1983 with 5, 10, and 20 year incidence of 5.0% (CI 3.9-6.1), 10.2% (CI 8.6-11.7), and 21.1% (CI 19.0-23.2), respectively. When stratifying by age at diagnosis, cumulative incidences of CVD death were highest among women diagnosed at age ≥ 70. Compared to white women, black women tended to have higher risk of death, especially among women diagnosed at young age; for those aged 40-49 at diagnosis, the HR for CVD mortality was 9.83 (95% CI 4.56-21.17). Conclusions: Among women diagnosed with DCIS, the risk of dying from CVD was greater than breast cancer at 20 years, with the incidence of CVD most pronounced among women diagnosed in an earlier treatment era (1978-1983) and older age. Black women had greater risks of dying from CVD compared to white women for all years, with this disparity decreasing with advanced age.

Breast-Conserving Treatment With or Without Radiotherapy in Ductal Carcinoma-In-Situ: Ten-Year Results of European Organisation for Research and Treatment of Cancer Randomized Phase III Trial 10853—A Study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group

2006 ◽  
Vol 24 (21) ◽  
pp. 3381-3387 ◽  
Author(s):  
Nina Bijker ◽  
Philip Meijnen ◽  
Johannes L. Peterse ◽  
Jan Bogaerts ◽  
Irène Van Hoorebeeck ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Phase Iii ◽  
Breast Conserving Treatment ◽  
European Organisation ◽  
Radiotherapy Group ◽  
Long Term Follow Up

Purpose The European Organisation for Research and Treatment of Cancer conducted a randomized trial investigating the role of radiotherapy (RT) after local excision (LE) of ductal carcinoma-in-situ (DCIS) of the breast. We analyzed the efficacy of RT with 10 years follow-up on both the overall risk of local recurrence (LR) and related to clinical, histologic, and treatment factors. Patients and Methods After complete LE, women with DCIS were randomly assigned to no further treatment or RT (50 Gy). One thousand ten women with mostly (71%) mammographically detected DCIS were included. The median follow-up was 10.5 years. Results The 10-year LR-free rate was 74% in the group treated with LE alone compared with 85% in the women treated by LE plus RT (log-rank P < .0001; hazard ratio [HR] = 0.53). The risk of DCIS and invasive LR was reduced by 48% (P = .0011) and 42% (P = .0065) respectively. Both groups had similar low risks of metastases and death. At multivariate analysis, factors significantly associated with an increased LR risk were young age (≤ 40 years; HR = 1.89), symptomatic detection (HR = 1.55), intermediately or poorly differentiated DCIS (as opposed to well-differentiated DCIS; HR = 1.85 and HR = 1.61 respectively), cribriform or solid growth pattern (as opposed to clinging/micropapillary subtypes; HR = 2.39 and HR = 2.25 respectively), doubtful margins (HR = 1.84), and treatment by LE alone (HR = 1.82). The effect of RT was homogeneous across all assessed risk factors. Conclusion With long-term follow-up, RT after LE for DCIS continued to reduce the risk of LR, with a 47% reduction at 10 years. All patient subgroups benefited from RT.

Sign in / Sign up

Export Citation Format

Share Document