Natasha K Stout1, Angel M Cronin2, Hajime Uno2, Elissa M Ozanne3, Michael J Hassett2, Elizabeth S Frank4, Caprice C Greenberg5, Rinaa S Punglia6. 1. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. 2. Division of Population Sciences, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA. 3. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA. 4. Dana-Farber/Harvard Cancer Center Breast Cancer Advocacy Group, Dana-Farber Cancer Institute, Boston, MA, USA. 5. Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, USA. 6. Department of Radiation Therapy, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA. rpunglia@partners.org.
Abstract
PURPOSE: As local therapies improve, contralateral breast cancer (CBC) risk for women with ductal carcinoma in situ (DCIS) may exceed the risk of a second ipsilateral breast cancer. We sought to determine whether estrogen-receptor (ER) status influenced CBC risk. METHODS: We identified women aged 40-79 with DCIS diagnosed between 1990 and 2002 using the Surveillance, Epidemiology, and End Results database. We used multivariable competing risk regression to examine predictors of time from index DCIS to CBC (invasive or in situ). RESULTS: Multivariable competing risk regression found ER status to be a highly significant predictor of CBC. The 10-year cumulative incidence was estimated to be 5.3% (95% CI 4.8-5.8%) among ER positive (ER+) cases and 3.3% (95% CI 2.6-4.0%) among ER negative (ER-). CONCLUSIONS: This finding suggests that ER+ DCIS may represent a field effect that confers increased propensity for developing cancer across breast tissue, regardless of laterality. In contrast, ER- DCIS may represent an isolated local event. Given that the majority of DCIS is ER+, and only a minority of DCIS patients receive hormonal therapy, consideration of ER status may influence treatment and surveillance approaches.
PURPOSE: As local therapies improve, contralateral breast cancer (CBC) risk for women with ductal carcinoma in situ (DCIS) may exceed the risk of a second ipsilateral breast cancer. We sought to determine whether estrogen-receptor (ER) status influenced CBC risk. METHODS: We identified women aged 40-79 with DCIS diagnosed between 1990 and 2002 using the Surveillance, Epidemiology, and End Results database. We used multivariable competing risk regression to examine predictors of time from index DCIS to CBC (invasive or in situ). RESULTS: Multivariable competing risk regression found ER status to be a highly significant predictor of CBC. The 10-year cumulative incidence was estimated to be 5.3% (95% CI 4.8-5.8%) among ER positive (ER+) cases and 3.3% (95% CI 2.6-4.0%) among ER negative (ER-). CONCLUSIONS: This finding suggests that ER+ DCIS may represent a field effect that confers increased propensity for developing cancer across breast tissue, regardless of laterality. In contrast, ER- DCIS may represent an isolated local event. Given that the majority of DCIS is ER+, and only a minority of DCIS patients receive hormonal therapy, consideration of ER status may influence treatment and surveillance approaches.
Entities:
Keywords:
Breast cancer; Ductal carcinoma in situ; Estrogen receptor; Recurrence
Authors: Abeer M Shaaban; Bridget Hilton; Karen Clements; Sarah E Pinder; Alastair M Thompson Journal: Br J Cancer Date: 2021-02-16 Impact factor: 7.640
Authors: Islam M Miligy; Michael S Toss; Sho Shiino; Georgette Oni; Binafsha M Syed; Hazem Khout; Qing Ting Tan; Andrew R Green; R Douglas Macmillan; John F R Robertson; Emad A Rakha Journal: Br J Cancer Date: 2020-08-10 Impact factor: 7.640