Type of recurrence, cause of death and second neoplasms among 737 patients with ductal carcinoma in situ of the breast: 15-year follow-up.

e12592 Background: The aim of the study is to assess the results of the treatment of 737 consecutive patients with DCIS with particular attention to the character of recurrences, other neoplasms and causes of deaths. Methods: A retrospective analysis was carried out of 737 consecutive DCIS patients treated in one institution in the years 1996-2011. The percentage of failures, causes of death, cumulated recurrence risk, DFS, OS depending on the method of treatment (mastectomy, breast conserving treatment BCT, breast conserving surgery BCS), was calculated. Results: 66 recurrences (42% DCIS, 58% invasive) were reported: 61 recurrences in the breast, 5 outside the breast. The comparison of mammography images before the initial treatment and after local recurrence revealed the true recurrence in the breast in 48/61 (79%) of cases. The cumulated recurrence risk after 15-year observation, after mastectomy, BCT and BCS was 3.2%, 19.5% and 31.2 %, respectively (p < 0.001). 15-year DFS after mastectomy, BCT and BCS was 72%, 65% and 48%, respectively (p < 0.001). 15-year OS after mastectomy, BCT and BCS was 75%, 83% and 70%, respectively, p = 0.329. In the course of the whole observation period 124 other neoplastic lesions in 121 patients (16%) were reported including 58 (8%) contralateral breast cancers. Deaths due to DCIS progression were reported in 4 (0.5%) of patients. An overwhelming majority (74/86) of deaths was linked to the age of the patients or other diseases, including other neoplasms. Conclusions: The highest recurrence risk reported in patients after BCS was unacceptable and, moreover, it kept growing over the fifteen years of observation. 79% of recurrences in the treated breast were true recurrences. Local recurrences were effectively treated without influence on OS. The percentage of deaths due to DCIS was low.

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Invasive Cancer Confined to the Nipple of the Conserved Breast: A Case Report

Case Reports in Oncology ◽

10.1159/000510309 ◽

2020 ◽

Vol 13 (3) ◽

pp. 1125-1130

Author(s):

Miyuki Kitahara ◽

Yasuo Hozumi ◽

Naoto Takeuchi ◽

Satoko Ichinohe ◽

Mitsuki Machinaga ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Lymph Node Biopsy ◽

Invasive Cancer ◽

Breast Cancer Patients ◽

Skin Changes ◽

True Recurrence ◽

The Right

Invasive breast cancer deriving from the milk duct and lobule that develops in the nipple is extremely rare, except in Paget’s disease and skin cancer. This is the second reported case of the development of invasive cancer confined to the nipple after breast-conserving surgery. A 69-year-old woman visited our department due to redness, swelling, and bloody discharge of the right nipple in the last month. A needle biopsy was suggestive of invasive ductal carcinoma; we performed a removal surgery of the right residual breast tissue and a second sentinel lymph node biopsy. She underwent these procedures 10 years previously as well. Thus, we diagnosed the present lesion as a local recurrence, but it was unknown whether the lesion was a true recurrence or second cancer, namely, metachronal ipsilateral breast cancer. The present case helps promote awareness that invasive cancer rarely develops in the nipple after conserving surgery. Patients should be encouraged to visit a medical facility if experiencing skin changes and swelling of the nipple. Additionally, breast cancer patients must be carefully selected for breast-conserving surgery; failure to do so may later result in nipple-specific local recurrence.

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Recurrence rates for ductal carcinoma in situ: Analysis of 2,996 patients treated with breast-conserving surgery over 30 years.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.32 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 32-32

Author(s):

Kimberly J. Van Zee ◽

Preeti Subhedar ◽

Cristina Olcese ◽

Sujata Patil ◽

Monica Morrow

Keyword(s):

Treatment Period ◽

Ductal Carcinoma ◽

Recurrence Risk ◽

Breast Conserving Surgery ◽

Recurrence Rates ◽

Cox Proportional Hazard ◽

Pathologic Assessment ◽

Cox Proportional Hazard Models ◽

History Presentation

32 Background: Randomized trials of radiation after breast-conserving surgery (BCS) for DCIS found substantial rates of recurrence, with half of recurrences invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed, and are largely attributed to systemic therapy improvements. Here we examine recurrence rates after BCS for DCIS over 3 decades at one institution. Methods: We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978–2010. Cox proportional hazard models were used to investigate the association between treatment period and recurrence, controlling for other variables. Results: 363 (12%) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0–30 years); 732 were followed for ≥ 10 years. The 5-year recurrence rate for 1978–1998 was 13.6% versus 6.6% for 1999–2010 (hazard ratio [HR] 0.62, p < 0.0001). After controlling for age, family history, presentation (radiologic vs clinical), nuclear grade (non-high vs. high grade), necrosis, number of excisions ( ≤ 2 vs ≥ 3), margin status (positive/close vs negative), radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p = 0.02) compared to earlier. After stratification by radiation use, and adjustment for 7 other factors, the decrease in recurrence rates was limited to those without radiation (HR 0.62, p = 0.003); there was no decline in recurrence rates among those receiving radiation (HR 1.13, p = 0.6). Conclusions: Recurrence rates for DCIS have fallen over time. Increases in screen-detection, negative margins, and use of adjuvant therapies only partially explain the decrease. The unexplained decline is limited to women not receiving radiation, suggesting it is not due to changes in radiation efficacy, but may be due to improvements in radiologic detection and pathologic assessment. The lower recurrence risk observed for DCIS patients treated in more recent years is important for patient education, especially in view of the widely reported recent increase in use of mastectomy.

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Ductal Carcinoma In Situ: What Can We Learn from Clinical Trials?

International Journal of Surgical Oncology ◽

10.1155/2012/296829 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7

Author(s):

Lucio Fortunato ◽

Igor Poccia ◽

Ugo de Paula ◽

Elena Santini

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Retrospective Studies ◽

Ductal Carcinoma ◽

Conservative Surgery ◽

Adjuvant Radiation ◽

Breast Cancers ◽

Treated Breast ◽

Clinical Conditions

Ductal Carcinoma in situ has been diagnosed more frequently in the last few years and now accounts for approximately one-fourth of all treated breast cancers. Traditionally, this disease has been treated with total mastectomy, but conservative surgery has become increasingly used in the absence of unfavourable clinical conditions, if a negative excision margin can be achieved. It is controversial whether subgroups of patients with favourable in situ tumors could be managed by conservative surgery alone, without radiation. As the disease is diagnosed more frequently in younger patients, these issues are very relevant, and much research has focused on this topic in the last two decades. We reviewed randomized trials regarding adjuvant radiation after breast-conservative surgery and compared data with available retrospective studies.

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Extent of ductal carcinoma in situ in breast conserving surgery specimens: correlation between radiographic measurement of microcalcification areas and histological measurement on large format slides

10.1055/s-0039-1688040 ◽

2019 ◽

Author(s):

B Radzinski ◽

T Loebsin ◽

D Gläser ◽

W Heindel ◽

S Weigel ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Radiographic Measurement ◽

Large Format ◽

Histological Measurement

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Impact of consensus guidelines for breast‐conserving surgery in patients with ductal carcinoma in situ

Cancer Reports ◽

10.1002/cnr2.1502 ◽

2021 ◽

Author(s):

Abigail Tremelling ◽

Rebecca L. Aft ◽

Amy E. Cyr ◽

William E. Gillanders ◽

Katherine Glover‐Collins ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Consensus Guidelines

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Managing cardiotoxicity in anthracycline-treated breast cancers

Expert Opinion on Drug Safety ◽

10.1517/14740338.6.3.315 ◽

2007 ◽

Vol 6 (3) ◽

pp. 315-321 ◽

Cited By ~ 14

Author(s):

Raymond Ng ◽

Michael D Green

Keyword(s):

Breast Cancers ◽

Treated Breast

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Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

European Radiology ◽

10.1007/s00330-021-07873-2 ◽

2021 ◽

Author(s):

Carlos Canelo-Aybar ◽

Alvaro Taype-Rondan ◽

Jessica Hanae Zafra-Tanaka ◽

David Rigau ◽

Axel Graewingholt ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Surgical Outcomes ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Cochrane Library ◽

Treatment Change ◽

The Impact

Abstract Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.

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

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06129-3 ◽

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.

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