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

Anthony J Maxwell (Lead / Corresponding author), 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

    Research output: Contribution to journalArticle

    13 Citations (Scopus)
    73 Downloads (Pure)

    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 - Apr 2018

    Fingerprint

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

    Keywords

    • Breast cancer
    • DCIS
    • Endocrine therapy
    • Invasion
    • Microcalcification
    • Surgery

    Cite this

    Maxwell, A. J., Clements, K., Hilton, B., Dodwell, D. J., Evans, A., Kearins, O., ... Sloane Project Steering Group (2018). Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ. European Journal of Surgical Oncology, 44(4), 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. / 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.
    @article{5f286de5d1884420b5a15bb088520030,
    title = "Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ",
    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.",
    keywords = "Breast cancer, DCIS, Endocrine therapy, Invasion, Microcalcification, Surgery",
    author = "Maxwell, {Anthony J} and Karen Clements and Bridget Hilton and Dodwell, {David J} and Andrew Evans and Olive Kearins and Pinder, {Sarah E} and Jeremy Thomas and Wallis, {Matthew G} and Thompson, {Alastair M} and {Sloane Project Steering Group}",
    note = "DD is supported by the University of Oxford, Cancer Research UK (grant C8225/A21133 ), the Medical Research Council and the British Heart Foundation.",
    year = "2018",
    month = "4",
    doi = "10.1016/j.ejso.2017.12.007",
    language = "English",
    volume = "44",
    pages = "429--435",
    journal = "European Journal of Surgical Oncology",
    issn = "0748-7983",
    publisher = "Elsevier",
    number = "4",

    }

    Maxwell, AJ, Clements, K, Hilton, B, Dodwell, DJ, Evans, A, Kearins, O, Pinder, SE, Thomas, J, Wallis, MG, Thompson, AM & Sloane Project Steering Group 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

    Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ. / Maxwell, Anthony J (Lead / Corresponding author); 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.

    In: European Journal of Surgical Oncology, Vol. 44, No. 4, 04.2018, p. 429-435.

    Research output: Contribution to journalArticle

    TY - JOUR

    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

    N1 - DD is supported by the University of Oxford, Cancer Research UK (grant C8225/A21133 ), the Medical Research Council and the British Heart Foundation.

    PY - 2018/4

    Y1 - 2018/4

    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.

    KW - Breast cancer

    KW - DCIS

    KW - Endocrine therapy

    KW - Invasion

    KW - Microcalcification

    KW - Surgery

    UR - http://www.scopus.com/inward/record.url?scp=85041569723&partnerID=8YFLogxK

    U2 - 10.1016/j.ejso.2017.12.007

    DO - 10.1016/j.ejso.2017.12.007

    M3 - Article

    VL - 44

    SP - 429

    EP - 435

    JO - European Journal of Surgical Oncology

    JF - European Journal of Surgical Oncology

    SN - 0748-7983

    IS - 4

    ER -