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Int J Clin Oncol. 2014;19(3):460-6. doi: 10.1007/s10147-013-0575-0. Epub 2013 Jun 19.

Breast conservation therapy for ductal carcinoma in situ (DCIS): does presentation of disease affect long-term outcomes?

Author information

1
Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208040, New Haven, CT, 06520-8040, USA.

Abstract

BACKGROUND:

For DCIS patients eligible for breast conservation treatment (BCT), it remains unclear whether presenting with physical signs/symptoms (Phys) confers a worse long-term prognosis compared to mammographically detected DCIS (Mam).

METHODS:

We collected data on 669 DCIS patients treated with BCT from 1974 to 2007 of whom 80 were identified as category "Phys" and 589 were in category "Mam."

RESULTS:

Treatment parameters (i.e., the RT dose delivered, boost, rates of stereotactic biopsy, re-excision, node dissection) did not differ significantly between the two cohorts (p = NS). At a 60-month median follow-up, significant associations included younger age at presentation (p < 0.001), non-white race (p = 0.041), larger tumor size (p = 0.002), more 1°/2° papillary histology (1°, p = 0.001; 2°, p = 0.005) for the Phys cohort. As expected, mammograms were more likely to show mass/nodules/asymmetrical densities and less likely to show microcalcifications for the Phys versus Mam group (p < 0.0001). There were no differences in family history, multifocality, grade, necrosis, or residual disease at re-excision, nodal involvement, status of margins, or ER/PR/HER-2 between the cohorts. The local relapse-free survival was similar at 5 years (100 vs. 96.9 %, p = 0.116) and 10 years (96.2 vs. 96.2 %, p = 0.906), with no significant overall survival difference at 10 years (97.5 vs. 95.9 %, p = 0.364) between the Phys and Mam patients, respectively. On multivariate analysis, presentation was not an independent predictor of local relapse-free survival or overall survival when accounting for age, race, tumor size, mammogram appearance, and adjuvant hormone treatment.

CONCLUSIONS:

Our findings suggest that although some clinicopathological differences exist between DCIS patients presenting with physical signs/symptoms compared with those presenting with mammographically detected disease, long-term outcomes are similar for patients appropriately selected for BCT.

PMID:
23780727
DOI:
10.1007/s10147-013-0575-0
[Indexed for MEDLINE]

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