Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ

Anthony J Maxwell, Karen Clements, Bridget Hilton, David J Dodwell, Andrew Evans, Olive Kearins, Sarah E Pinder, Jeremy Thomas, Matthew G Wallis, Alastair M Thompson, Sloane Project Steering Group, Valerie Speirs

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Abstract

BACKGROUND: The natural history of ductal carcinoma in situ (DCIS) remains uncertain. The risk factors for the development of invasive cancer in unresected DCIS are unclear.

METHODS: Women diagnosed with DCIS on needle biopsy after 1997 who did not undergo surgical resection for ≥1 year after diagnosis were identified by breast centres and the cancer registry and outcomes were reviewed.

RESULTS: Eighty-nine women with DCIS diagnosed 1998-2010 were identified. The median age at diagnosis was 75 (range 44-94) years with median follow-up (diagnosis to death, invasive disease or last review) of 59 (12-180) months. Twenty-nine women (33%) developed invasive breast cancer after a median interval of 45 (12-144) months. 14/29 (48%) with high grade, 10/31 (32%) with intermediate grade and 3/17 (18%) with low grade DCIS developed invasive cancer after median intervals of 38, 60 and 51 months. The cumulative incidence of invasion was significantly higher in high grade DCIS than other grades (p = .0016, log-rank test). Invasion was more frequent in lesions with calcification as the predominant feature (23/50 v. 5/25; p = .042) and in younger women (p = .0002). Endocrine therapy was associated with a lower rate of invasive breast cancer (p = .048).

CONCLUSIONS: High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.

Original languageEnglish
Pages (from-to)429-435
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume44
Issue number4
Early online date11 Jan 2018
DOIs
Publication statusPublished - 30 Apr 2018

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Carcinoma, Intraductal, Noninfiltrating
Neoplasms
Breast Neoplasms
Calcinosis
Needle Biopsy
Natural History
Registries
Therapeutics
Clinical Trials
Incidence

Keywords

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Breast Carcinoma In Situ
  • Breast Neoplasms
  • Calcinosis
  • Carcinoma, Intraductal, Noninfiltrating
  • Disease Progression
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Invasiveness
  • Prognosis
  • Registries
  • Risk Factors
  • Journal Article

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Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ. / Maxwell, Anthony J; Clements, Karen; Hilton, Bridget; Dodwell, David J; Evans, Andrew; Kearins, Olive; Pinder, Sarah E; Thomas, Jeremy; Wallis, Matthew G; Thompson, Alastair M; Sloane Project Steering Group ; Speirs, Valerie.

In: European Journal of Surgical Oncology, Vol. 44, No. 4, 30.04.2018, p. 429-435.

Research output: Contribution to journalArticle

Maxwell, AJ, Clements, K, Hilton, B, Dodwell, DJ, Evans, A, Kearins, O, Pinder, SE, Thomas, J, Wallis, MG, Thompson, AM, Sloane Project Steering Group & Speirs, V 2018, 'Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ', European Journal of Surgical Oncology, vol. 44, no. 4, pp. 429-435. https://doi.org/10.1016/j.ejso.2017.12.007
Maxwell, Anthony J ; Clements, Karen ; Hilton, Bridget ; Dodwell, David J ; Evans, Andrew ; Kearins, Olive ; Pinder, Sarah E ; Thomas, Jeremy ; Wallis, Matthew G ; Thompson, Alastair M ; Sloane Project Steering Group ; Speirs, Valerie. / Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ. In: European Journal of Surgical Oncology. 2018 ; Vol. 44, No. 4. pp. 429-435.
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abstract = "BACKGROUND: The natural history of ductal carcinoma in situ (DCIS) remains uncertain. The risk factors for the development of invasive cancer in unresected DCIS are unclear.METHODS: Women diagnosed with DCIS on needle biopsy after 1997 who did not undergo surgical resection for ≥1 year after diagnosis were identified by breast centres and the cancer registry and outcomes were reviewed.RESULTS: Eighty-nine women with DCIS diagnosed 1998-2010 were identified. The median age at diagnosis was 75 (range 44-94) years with median follow-up (diagnosis to death, invasive disease or last review) of 59 (12-180) months. Twenty-nine women (33{\%}) developed invasive breast cancer after a median interval of 45 (12-144) months. 14/29 (48{\%}) with high grade, 10/31 (32{\%}) with intermediate grade and 3/17 (18{\%}) with low grade DCIS developed invasive cancer after median intervals of 38, 60 and 51 months. The cumulative incidence of invasion was significantly higher in high grade DCIS than other grades (p = .0016, log-rank test). Invasion was more frequent in lesions with calcification as the predominant feature (23/50 v. 5/25; p = .042) and in younger women (p = .0002). Endocrine therapy was associated with a lower rate of invasive breast cancer (p = .048).CONCLUSIONS: High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.",
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T1 - Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ

AU - Maxwell, Anthony J

AU - Clements, Karen

AU - Hilton, Bridget

AU - Dodwell, David J

AU - Evans, Andrew

AU - Kearins, Olive

AU - Pinder, Sarah E

AU - Thomas, Jeremy

AU - Wallis, Matthew G

AU - Thompson, Alastair M

AU - Sloane Project Steering Group

AU - Speirs, Valerie

N1 - Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

PY - 2018/4/30

Y1 - 2018/4/30

N2 - BACKGROUND: The natural history of ductal carcinoma in situ (DCIS) remains uncertain. The risk factors for the development of invasive cancer in unresected DCIS are unclear.METHODS: Women diagnosed with DCIS on needle biopsy after 1997 who did not undergo surgical resection for ≥1 year after diagnosis were identified by breast centres and the cancer registry and outcomes were reviewed.RESULTS: Eighty-nine women with DCIS diagnosed 1998-2010 were identified. The median age at diagnosis was 75 (range 44-94) years with median follow-up (diagnosis to death, invasive disease or last review) of 59 (12-180) months. Twenty-nine women (33%) developed invasive breast cancer after a median interval of 45 (12-144) months. 14/29 (48%) with high grade, 10/31 (32%) with intermediate grade and 3/17 (18%) with low grade DCIS developed invasive cancer after median intervals of 38, 60 and 51 months. The cumulative incidence of invasion was significantly higher in high grade DCIS than other grades (p = .0016, log-rank test). Invasion was more frequent in lesions with calcification as the predominant feature (23/50 v. 5/25; p = .042) and in younger women (p = .0002). Endocrine therapy was associated with a lower rate of invasive breast cancer (p = .048).CONCLUSIONS: High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.

AB - BACKGROUND: The natural history of ductal carcinoma in situ (DCIS) remains uncertain. The risk factors for the development of invasive cancer in unresected DCIS are unclear.METHODS: Women diagnosed with DCIS on needle biopsy after 1997 who did not undergo surgical resection for ≥1 year after diagnosis were identified by breast centres and the cancer registry and outcomes were reviewed.RESULTS: Eighty-nine women with DCIS diagnosed 1998-2010 were identified. The median age at diagnosis was 75 (range 44-94) years with median follow-up (diagnosis to death, invasive disease or last review) of 59 (12-180) months. Twenty-nine women (33%) developed invasive breast cancer after a median interval of 45 (12-144) months. 14/29 (48%) with high grade, 10/31 (32%) with intermediate grade and 3/17 (18%) with low grade DCIS developed invasive cancer after median intervals of 38, 60 and 51 months. The cumulative incidence of invasion was significantly higher in high grade DCIS than other grades (p = .0016, log-rank test). Invasion was more frequent in lesions with calcification as the predominant feature (23/50 v. 5/25; p = .042) and in younger women (p = .0002). Endocrine therapy was associated with a lower rate of invasive breast cancer (p = .048).CONCLUSIONS: High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.

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KW - Breast Neoplasms

KW - Calcinosis

KW - Carcinoma, Intraductal, Noninfiltrating

KW - Disease Progression

KW - Female

KW - Humans

KW - Middle Aged

KW - Neoplasm Grading

KW - Neoplasm Invasiveness

KW - Prognosis

KW - Registries

KW - Risk Factors

KW - Journal Article

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DO - 10.1016/j.ejso.2017.12.007

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VL - 44

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JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

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