TY - JOUR
T1 - Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ
T2 - the UK Sloane Project
AU - Sloane Project Steering Group (NHS Prospective Study of Screen-Detected Non-invasive Neoplasias)
AU - Thompson, Alastair M.
AU - Clements, Karen
AU - Cheung, Shan
AU - Pinder, Sarah E.
AU - Lawrence, Gillian
AU - Sawyer, Elinor
AU - Kearins, Olive
AU - Ball, Graham R.
AU - Tomlinson, Ian
AU - Hanby, Andrew
AU - Thomas, Jeremy St J.
AU - Maxwell, Anthony J.
AU - Wallis, Matthew G.
AU - Dodwell, David J.
AU - Thompson, Alastair
AU - Francis, Adele
AU - Sibbering, Mark
AU - Bishop, Hugh
AU - Carpenter, Robert
AU - George, W. D.
AU - Lee, Martin
AU - Nicholson, Stewart
AU - Dobson, Hilary
AU - Evans, Andy
AU - Wallis, Matthew
AU - Dodwell, David
AU - Sawyer, Elinor
AU - Adlard, Julian
AU - Dewar, John
AU - Ross, Gillian
AU - Wilcox, Maggie
AU - Hanby, Andrew
AU - Pinder, Sarah
AU - Speirs, Valerie
AU - Thomas, Jeremy
AU - Ellis, Ian
AU - Lakhani, Sunil
AU - Macartney, James
AU - Cheung, Shan
AU - Lawrence, Gillian
AU - Ball, Graham
AU - Hilton, Bridget
AU - Kearins, Olive
AU - Wheaton, Margot
N1 - Funding Information:
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.
Publisher Copyright:
© 2018
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - Ductal carcinoma in situ
KW - Margins
KW - Radiotherapy
KW - Recurrence
UR - http://www.scopus.com/inward/record.url?scp=85050960683&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2018.06.027
DO - 10.1016/j.ejca.2018.06.027
M3 - Article
C2 - 30092498
AN - SCOPUS:85050960683
SN - 0959-8049
VL - 101
SP - 210
EP - 219
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -
