Skip to main content

Advertisement

Log in

Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Randomized trials have demonstrated the efficacy of radiation and tamoxifen in reducing risk of second events after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS), but the comparative effectiveness of mastectomy, BCS, and adjuvant treatments have not been established in community practice. We examined disease-free survival (DFS) among 1,676 DCIS cases diagnosed during 1995–2006 in the population-based Wisconsin In Situ Cohort study. Information on patient and tumor characteristics, treatments, and second breast cancer events were collected via a comprehensive review of data from patient interviews, the statewide cancer registry, and pathology reports. Breast cancer DFS was evaluated according to treatment while adjusting for patient and tumor characteristics. After an average of 7.1 years of follow-up, 143 second breast cancer events occurred. Overall 5-year DFS was similar among women treated with ipsilateral mastectomy (95.6 %; 95 % CI 93.5–97.0) compared to women treated with BCS and radiation (94.8 %; 95 % CI 92.8–96.1), though women receiving BCS without radiation experienced poorer overall DFS (87.0 %; 95 % CI 80.6–91.5). Women treated with tamoxifen in addition to BCS and radiation had a similar risk of a second breast event, although the hazard ratio (HR) suggested a potential benefit (0.70, 95% CI 0.41-1.19). Women treated with BCS, radiation, and tamoxifen had comparable risk of a second event as those treated with ipsilateral mastectomy (HR = 1.20; 95 % CI 0.71–2.02). In this population-based sample, the use of BCS with radiation and tamoxifen resulted in high DFS rates comparable to those achieved by ipsilateral mastectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Silverstein MJ, Baril NB (2002) In situ carcinoma of the breast. In: Donegan WL, Spratt JS (eds) Cancer of the breast, 5th edn. Saunders, Philadelphia

    Google Scholar 

  2. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C (1996) Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 275(12):913–918

    Article  CAS  PubMed  Google Scholar 

  3. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H et al (2012) SEER cancer statistics review, 1975–2009. National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, April 2012

  4. American Cancer Society (2012) Cancer facts & figures 2012. American Cancer Society, Inc., Atlanta

  5. Sprague BL, Trentham-Dietz A (2010) In situ breast cancer. In: Li CI (ed) Breast cancer epidemiology. Springer, New York, pp 47–72

    Chapter  Google Scholar 

  6. Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA et al (2010) National institutes of health state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ September 22–24, 2009. J Natl Cancer Inst 102(3):161–169

    Article  PubMed  Google Scholar 

  7. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R (2000) Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med 160(7):953–958

    Article  CAS  PubMed  Google Scholar 

  8. Schairer C, Mink PJ, Carroll L, Devesa SS (2004) Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 96(17):1311–1321

    Article  PubMed  Google Scholar 

  9. Kerlikowske K (2010) Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr 2010(41):139–141

    Article  PubMed  Google Scholar 

  10. Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, Land SR, Margolese RG, Swain SM, Costantino JP et al (2011) Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 103(6):478–488

    Article  PubMed Central  PubMed  Google Scholar 

  11. Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, Forbes JF, Bishop H, Fentiman IS, George WD (2011) Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 12(1):21–29

    Article  CAS  PubMed  Google Scholar 

  12. Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, Gennaro M, Rouanet P, Avril A, Fentiman IS et al (2006) Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853: a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 24(21):3381–3387

    Article  PubMed  Google Scholar 

  13. Holmberg L, Garmo H, Granstrand B, Ringberg A, Arnesson LG, Sandelin K, Karlsson P, Anderson H, Emdin S (2008) Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol 26(8):1247–1252

    Article  PubMed  Google Scholar 

  14. Boyages J, Delaney G, Taylor R (1999) Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer 85(3):616–628

    Article  CAS  PubMed  Google Scholar 

  15. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Hampton JM, Newcomb PA (2007) Oral contraceptive use and risk of breast carcinoma in situ. Cancer Epidemiol Biomarkers Prev 16(11):2262–2268

    Article  CAS  PubMed  Google Scholar 

  16. Sprague BL, Trentham-Dietz A, Nichols HB, Hampton JM, Newcomb PA (2010) Change in lifestyle behaviors and medication use after a diagnosis of ductal carcinoma in situ. Breast Cancer Res Treat 124(2):487–495

    Article  PubMed Central  PubMed  Google Scholar 

  17. Schafer JL (1997) Analysis of incomplete multivariate data. Chapman and Hall, London

    Book  Google Scholar 

  18. Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, Wolmark N, Wickerham DL, Deutsch M, Ore L et al (1993) Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 328(22):1581–1586

    Article  CAS  PubMed  Google Scholar 

  19. Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E (1995) Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) Protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The National Surgical Adjuvant Breast and Bowel Project Collaborating Investigators. Cancer 75(6):1310–1319

    Article  CAS  PubMed  Google Scholar 

  20. Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, Fisher ER, Wickerham DL, Deutsch M, Margolese R et al (1998) Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 16(2):441–452

    CAS  PubMed  Google Scholar 

  21. Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, Wolmark N (1999) Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer 86(3):429–438

    Article  CAS  PubMed  Google Scholar 

  22. Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, Smith R, Begovic M, Dimitrov NV, Margolese RG et al (1999) Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 353(9169):1993–2000

    Article  CAS  PubMed  Google Scholar 

  23. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N (2001) Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the national surgical adjuvant breast and bowel project experience. Semin Oncol 28(4):400–418

    Article  CAS  PubMed  Google Scholar 

  24. Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, Peto R, Bijker N, Solin L, Darby S (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010(41):162–177

    Article  CAS  PubMed  Google Scholar 

  25. Habel LA, Daling JR, Newcomb PA, Self SG, Porter PL, Stanford JL, Seidel K, Weiss NS (1998) Risk of recurrence after ductal carcinoma in situ of the breast. Cancer Epidemiol Biomarkers Prev 7(8):689–696

    CAS  PubMed  Google Scholar 

  26. Warren JL, Weaver DL, Bocklage T, Key CR, Platz CE, Cronin KA, Ballard-Barbash R, Willey SC, Harlan LC (2005) The frequency of ipsilateral second tumors after breast-conserving surgery for DCIS: a population based analysis. Cancer 104(9):1840–1848

    Article  PubMed  Google Scholar 

  27. Smith BD, Haffty BG, Buchholz TA, Smith GL, Galusha DH, Bekelman JE, Gross CP (2006) Effectiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst 98(18):1302–1310

    Article  PubMed  Google Scholar 

  28. Petrelli F, Barni S (2011) Tamoxifen added to radiotherapy and surgery for the treatment of ductal carcinoma in situ of the breast: a meta-analysis of 2 randomized trials. Radiother Oncol 100(2):195–199

    Article  CAS  PubMed  Google Scholar 

  29. Habel LA, Achacoso NS, Haque R, Nekhlyudov L, Fletcher SW, Schnitt SJ, Collins LC, Geiger AM, Puligandla B, Acton L et al (2009) Declining recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting. Breast Cancer Res 11(6):R85

    Article  PubMed Central  PubMed  Google Scholar 

  30. Meijnen P, Oldenburg HS, Peterse JL, Bartelink H, Rutgers EJ (2008) Clinical outcome after selective treatment of patients diagnosed with ductal carcinoma in situ of the breast. Ann Surg Oncol 15(1):235–243

    Article  PubMed  Google Scholar 

  31. Schouten van der Velden AP, van Vugt R, Van Dijck JA, Leer JW, Wobbes T (2007) Local recurrences after different treatment strategies for ductal carcinoma in situ of the breast: a population-based study in the East Netherlands. Int J Radiat Oncol Biol Phys 69(3):703–710

    Article  PubMed  Google Scholar 

  32. Dick AW, Sorbero MS, Ahrendt GM, Hayman JA, Gold HT, Schiffhauer L, Stark A, Griggs JJ (2011) Comparative effectiveness of ductal carcinoma in situ management and the roles of margins and surgeons. J Natl Cancer Inst 103(2):92–104

    Article  PubMed Central  PubMed  Google Scholar 

  33. Falk RS, Hofvind S, Skaane P, Haldorsen T (2011) Second events following ductal carcinoma in situ of the breast: a register-based cohort study. Breast Cancer Res Treat 129(3):929–938

    Article  CAS  PubMed  Google Scholar 

  34. McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T, Engel JM, Onitilo AA (2012) Variability in reexcision following breast conservation surgery. JAMA 307(5):467–475

    Article  PubMed  Google Scholar 

  35. Greenland S, Finkle WD (1995) A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol 142(12):1255–1264

    CAS  PubMed  Google Scholar 

  36. Sprague BL, Trentham-Dietz A (2009) Prevalence of breast carcinoma in situ in the United States. JAMA 302(8):846–848

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Soerjomataram I, Louwman WJ, van der Sangen MJ, Roumen RM, Coebergh JW (2006) Increased risk of second malignancies after in situ breast carcinoma in a population-based registry. Br J Cancer 95(3):393–397

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Ganz PA (2010) Quality-of-life issues in patients with ductal carcinoma in situ. J Natl Cancer Inst Monogr 2010(41):218–222

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

National Cancer Institute (U54 CA163303, R01 CA67264, R01 CA47147, P30 CA14520); Department of Defense Breast Cancer Research Program (BC102357); American Society of Preventive Oncology sponsored by Susan G. Komen for the Cure and the Prevent Cancer Foundation (PCF-0596). We would like to thank Drs. Andreas Friedl, Kathleen Egan, Linda Titus, Hazel Nichols, and Shaneda Warren Andersen, along with Kathy Peck, Julie McGregor, Laura Stephenson and the Wisconsin Cancer Reporting System.

Disclosures

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brian L. Sprague.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sprague, B.L., McLaughlin, V., Hampton, J.M. et al. Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study. Breast Cancer Res Treat 141, 145–154 (2013). https://doi.org/10.1007/s10549-013-2670-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-013-2670-3

Keywords

Navigation