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Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project.

Accepted version
Peer-reviewed

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Article

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Authors

Thompson, Alastair M 
Clements, Karen 
Cheung, Shan 
Pinder, Sarah E 
Lawrence, Gill 

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.

Description

Keywords

Ductal carcinoma in situ, Margins, Radiotherapy, Recurrence, Aged, Aged, 80 and over, Antineoplastic Agents, Hormonal, Breast Neoplasms, Carcinoma in Situ, Carcinoma, Ductal, Breast, Chemotherapy, Adjuvant, Combined Modality Therapy, Female, Humans, Mass Screening, Mastectomy, Mastectomy, Segmental, Middle Aged, Neoplasm Recurrence, Local, Prospective Studies, Radiotherapy, Survival Analysis, Treatment Outcome, United Kingdom

Journal Title

Eur J Cancer

Conference Name

Journal ISSN

0959-8049
1879-0852

Volume Title

101

Publisher

Elseveir
Sponsorship
Principal funding is from Public Health England [PHE] (previously United Kingdom National Health Service Breast Screening Programme [NHSBSP]). Individuals who contribute to the Sloane Project are also supported by the Breast Cancer Research Trust, Breast Cancer Now and Cancer Research UK (grant no C8225/ A21133). The Sloane Project has previously received an unrestricted educational grant for 3 years from Pfizer, UK and from the Breast Cancer Research Trust, UK via a 2-year project grant..