Alastair M Thompson1, Karen Clements2, Shan Cheung3, Sarah E Pinder4, Gill Lawrence5, Elinor Sawyer6, Olive Kearins7, Graham R Ball8, Ian Tomlinson9, Andrew Hanby10, Jeremy St J Thomas11, Anthony J Maxwell12, Matthew G Wallis13, David J Dodwell14. 1. University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: AThompson1@mdanderson.org. 2. Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, B3 2PW, UK. Electronic address: karen.clements@phe.gov.uk. 3. Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, B3 2PW, UK. Electronic address: shan.cheung@phe.gov.uk. 4. Division of Cancer Studies, King's College London, 9th Floor Innovation Hub, Comprehensive Cancer Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK. Electronic address: sarah.pinder@kcl.ac.uk. 5. Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, B3 2PW, UK. Electronic address: oldpogill@gmail.com. 6. Division of Cancer Studies, King's College London, 9th Floor Innovation Hub, Comprehensive Cancer Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK. Electronic address: elinor.sawyer@kcl.ac.uk. 7. Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, B3 2PW, UK. Electronic address: Olive.Kearins@phe.gov.uk. 8. John van Geest Cancer Research Centre, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, UK. Electronic address: graham.ball@ntu.ac.uk. 9. Oxford Centre for Cancer Gene Research, Molecular Pathology and Diagnostics Theme, Oxford NIHR Comprehensive Biomedical Research Centre, Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, UK. Electronic address: ian.tomlinson@well.ox.ac.uk. 10. Leeds Institute of Cancer and Pathology (LICAP), Section of Pathology and Tumour Biology, Wellcome Trust Brenner Building, Level 4, Room 4.13 St James's University Hospital, Beckett Street, Leeds, LS9 7TF UK. Electronic address: a.m.hanby@leeds.ac.uk. 11. Western General Hospital, Edinburgh, EH4 2XU UK. Electronic address: jeremy.thomas@luht.scot.nhs.uk. 12. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK; School of Health Sciences, University of Manchester, Manchester, M13 9PT, UK. Electronic address: anthony.maxwell@manchester.ac.uk. 13. Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge & NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK. Electronic address: matthew.wallis@addenbrookes.nhs.uk. 14. Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK. Electronic address: david.dodwell@nhs.net.
Abstract
BACKGROUND: Management of screen-detected ductal carcinoma in situ (DCIS) remains controversial. METHODS: A prospective cohort of patients with DCIS diagnosed through the UK National Health Service Breast Screening Programme (1st April 2003 to 31st March 2012) was linked to national databases and case note review to analyse patterns of care, recurrence and mortality. RESULTS: Screen-detected DCIS in 9938 women, with mean age of 60 years (range 46-87), was treated by mastectomy (2931) or breast conserving surgery (BCS) (7007; 70%). At 64 months median follow-up, 697 (6.8%) had further DCIS or invasive breast cancer after BCS (7.8%) or mastectomy (4.5%) (p < 0.001). Breast radiotherapy (RT) after BCS (4363/7007; 62.3%) was associated with a 3.1% absolute reduction in ipsilateral recurrent DCIS or invasive breast cancer (no RT: 7.2% versus RT: 4.1% [p < 0.001]) and a 1.9% absolute reduction for ipsilateral invasive breast recurrence (no RT: 3.8% versus RT: 1.9% [p < 0.001]), independent of the excision margin width or size of DCIS. Women without RT after BCS had more ipsilateral breast recurrences (p < 0.001) when the radial excision margin was <2 mm. Adjuvant endocrine therapy (1208/9938; 12%) was associated with a reduction in any ipsilateral recurrence, whether RT was received (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.41-0.80) or not (HR 0.68; 95% CI 0.51-0.91) after BCS. Women who developed invasive breast recurrence had a worse survival than those with recurrent DCIS (p < 0.001). Among 321 (3.2%) who died, only 46 deaths were attributed to invasive breast cancer. CONCLUSION: Recurrent DCIS or invasive cancer is uncommon after screen-detected DCIS. Both RT and endocrine therapy were associated with a reduction in further events but not with breast cancer mortality within 5 years of diagnosis. Further research to identify biomarkers of recurrence risk, particularly as invasive disease, is indicated.
BACKGROUND: Management of screen-detected ductal carcinoma in situ (DCIS) remains controversial. METHODS: A prospective cohort of patients with DCIS diagnosed through the UK National Health Service Breast Screening Programme (1st April 2003 to 31st March 2012) was linked to national databases and case note review to analyse patterns of care, recurrence and mortality. RESULTS: Screen-detected DCIS in 9938 women, with mean age of 60 years (range 46-87), was treated by mastectomy (2931) or breast conserving surgery (BCS) (7007; 70%). At 64 months median follow-up, 697 (6.8%) had further DCIS or invasive breast cancer after BCS (7.8%) or mastectomy (4.5%) (p < 0.001). Breast radiotherapy (RT) after BCS (4363/7007; 62.3%) was associated with a 3.1% absolute reduction in ipsilateral recurrent DCIS or invasive breast cancer (no RT: 7.2% versus RT: 4.1% [p < 0.001]) and a 1.9% absolute reduction for ipsilateral invasive breast recurrence (no RT: 3.8% versus RT: 1.9% [p < 0.001]), independent of the excision margin width or size of DCIS. Women without RT after BCS had more ipsilateral breast recurrences (p < 0.001) when the radial excision margin was <2 mm. Adjuvant endocrine therapy (1208/9938; 12%) was associated with a reduction in any ipsilateral recurrence, whether RT was received (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.41-0.80) or not (HR 0.68; 95% CI 0.51-0.91) after BCS. Women who developed invasive breast recurrence had a worse survival than those with recurrent DCIS (p < 0.001). Among 321 (3.2%) who died, only 46 deaths were attributed to invasive breast cancer. CONCLUSION: Recurrent DCIS or invasive cancer is uncommon after screen-detected DCIS. Both RT and endocrine therapy were associated with a reduction in further events but not with breast cancer mortality within 5 years of diagnosis. Further research to identify biomarkers of recurrence risk, particularly as invasive disease, is indicated.
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Authors: Mangesh A Thorat; Pauline M Levey; J Louise Jones; Sarah E Pinder; Nigel J Bundred; Ian S Fentiman; Jack Cuzick Journal: Clin Cancer Res Date: 2021-10-01 Impact factor: 12.531
Authors: Mangesh A Thorat; Pauline M Levey; J Louise Jones; Sarah E Pinder; Nigel J Bundred; Ian S Fentiman; Jack Cuzick Journal: Clin Cancer Res Date: 2021-03-16 Impact factor: 12.531