Megan E Tesch1, Shoshana M Rosenberg2, Laura C Collins3,4, Julia S Wong1,4,5, Laura Dominici1,4,5, Kathryn J Ruddy6, Rulla Tamimi2, Lidia Schapira7,8, Virginia F Borges9, Ellen Warner10, Steven E Come3,4, Ann H Partridge11,12,13. 1. Dana-Farber Cancer Institute, Boston, MA, USA. 2. Weill Cornell Medicine, New York, NY, USA. 3. Beth Israel Deaconess, Boston, MA, USA. 4. Harvard Medical School, Boston, MA, USA. 5. Brigham and Women's Hospital, Boston, MA, USA. 6. Mayo Clinic, Rochester, MN, USA. 7. Stanford University, Stanford, CA, USA. 8. Stanford Cancer Institute, Stanford, CA, USA. 9. University of Colorado Cancer Center, Denver, CO, USA. 10. Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 11. Dana-Farber Cancer Institute, Boston, MA, USA. ann_partridge@dfci.harvard.edu. 12. Harvard Medical School, Boston, MA, USA. ann_partridge@dfci.harvard.edu. 13. Brigham and Women's Hospital, Boston, MA, USA. ann_partridge@dfci.harvard.edu.
Abstract
BACKGROUND: Ductal carcinoma in situ (DCIS) is uncommon and understudied in young women. The objective of this study is to describe clinicopathologic features, treatment, and oncologic outcomes in a modern cohort of women aged ≤ 40 years with DCIS. PATIENTS AND METHODS: Patients with DCIS were identified from the Young Women's Breast Cancer Study, a multisite prospective cohort of women diagnosed with stage 0-IV breast cancer at age ≤ 40 years, enrolled from 2006 to 2016. Clinical data were collected from patient surveys and medical records. Pathologic features were examined by central review. Data were summarized with descriptive statistics and groups were compared with χ2 and Fisher's exact tests. RESULTS: Among the 98 patients included, median age of diagnosis was 38 years; 36 (37%) patients were symptomatic on presentation. DCIS nuclear grade was high in 35%, intermediate in 50%, and low in 15% of lesions; 36% of lesions had comedonecrosis. The majority of patients underwent bilateral mastectomy (57%), 16 (16%) underwent unilateral mastectomy, and 26 (27%) underwent lumpectomy, most of whom received radiation. Few (13%) patients were receiving tamoxifen therapy 1 year postdiagnosis. Over a median follow-up of 8.4 years, six patients (6%) had disease recurrence, including five locoregional and one distant event. CONCLUSIONS: A high proportion of young women with DCIS underwent mastectomy with or without contralateral prophylactic mastectomy. Although DCIS was frequently symptomatic on presentation and exhibited unfavorable pathologic factors, clinicopathologic features were overall heterogeneous and few recurrences occurred. This underscores the need for careful consideration of treatment options in young women with DCIS.
BACKGROUND: Ductal carcinoma in situ (DCIS) is uncommon and understudied in young women. The objective of this study is to describe clinicopathologic features, treatment, and oncologic outcomes in a modern cohort of women aged ≤ 40 years with DCIS. PATIENTS AND METHODS: Patients with DCIS were identified from the Young Women's Breast Cancer Study, a multisite prospective cohort of women diagnosed with stage 0-IV breast cancer at age ≤ 40 years, enrolled from 2006 to 2016. Clinical data were collected from patient surveys and medical records. Pathologic features were examined by central review. Data were summarized with descriptive statistics and groups were compared with χ2 and Fisher's exact tests. RESULTS: Among the 98 patients included, median age of diagnosis was 38 years; 36 (37%) patients were symptomatic on presentation. DCIS nuclear grade was high in 35%, intermediate in 50%, and low in 15% of lesions; 36% of lesions had comedonecrosis. The majority of patients underwent bilateral mastectomy (57%), 16 (16%) underwent unilateral mastectomy, and 26 (27%) underwent lumpectomy, most of whom received radiation. Few (13%) patients were receiving tamoxifen therapy 1 year postdiagnosis. Over a median follow-up of 8.4 years, six patients (6%) had disease recurrence, including five locoregional and one distant event. CONCLUSIONS: A high proportion of young women with DCIS underwent mastectomy with or without contralateral prophylactic mastectomy. Although DCIS was frequently symptomatic on presentation and exhibited unfavorable pathologic factors, clinicopathologic features were overall heterogeneous and few recurrences occurred. This underscores the need for careful consideration of treatment options in young women with DCIS.
Authors: F A Vicini; L L Kestin; N S Goldstein; P Y Chen; J Pettinga; R C Frazier; A A Martinez Journal: J Clin Oncol Date: 2000-01 Impact factor: 44.544
Authors: K J Van Zee; L Liberman; B Samli; K N Tran; B McCormick; J A Petrek; P P Rosen; P I Borgen Journal: Cancer Date: 1999-11-01 Impact factor: 6.860
Authors: Lawrence J Solin; Alain Fourquet; Frank A Vicini; Marie Taylor; Ivo A Olivotto; Bruce Haffty; Eric A Strom; Lori J Pierce; Lawrence B Marks; Harry Bartelink; Marsha D McNeese; Anuja Jhingran; Elaine Wai; Nina Bijker; Francois Campana; Wei-Ting Hwang Journal: Cancer Date: 2005-03-15 Impact factor: 6.860
Authors: Irene L Wapnir; James J Dignam; Bernard Fisher; Eleftherios P Mamounas; Stewart J Anderson; Thomas B Julian; Stephanie R Land; Richard G Margolese; Sandra M Swain; Joseph P Costantino; Norman Wolmark Journal: J Natl Cancer Inst Date: 2011-03-11 Impact factor: 13.506
Authors: I Kong; S A Narod; C Taylor; L Paszat; R Saskin; S Nofech-Moses; D Thiruchelvam; W Hanna; J P Pignol; S Sengupta; L Elavathil; P A Jani; S J Done; S Metcalfe; E Rakovitch Journal: Curr Oncol Date: 2014-02 Impact factor: 3.677
Authors: Lawrence J Solin; Robert Gray; Frederick L Baehner; Steven M Butler; Lorie L Hughes; Carl Yoshizawa; Diana B Cherbavaz; Steven Shak; David L Page; George W Sledge; Nancy E Davidson; James N Ingle; Edith A Perez; William C Wood; Joseph A Sparano; Sunil Badve Journal: J Natl Cancer Inst Date: 2013-05-02 Impact factor: 13.506