Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer

Daniele Giardiello; Iris Kramer; Maartje J. Hooning; Michael Hauptmann; Esther H. Lips; Elinor Sawyer; Alastair M. Thompson; Linda de Munck; Sabine Siesling; Jelle Wesseling; Ewout W. Steyerberg; Marjanka K. Schmidt

doi:10.1038/s41523-020-00202-8

Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer

Daniele Giardiello, Iris Kramer, Maartje J. Hooning, Michael Hauptmann, Esther H. Lips, Elinor Sawyer, Alastair M. Thompson, Linda de Munck, Sabine Siesling, Jelle Wesseling, Ewout W. Steyerberg, Marjanka K. Schmidt^*

^*Corresponding author for this work

Comprehensive Cancer Centre

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N = 28,003) or stage I–III BC (N = 275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, separate analyses were performed for stage I BC without adjuvant systemic therapy and by mode of first BC detection. Multivariable models including clinico-pathological and treatment data were created to assess CBC risk prediction performance in DCIS patients. The 10-year cumulative incidence of invasive CBC was 4.8% for DCIS patients (CBC = 1334). Invasive CBC risk was higher in DCIS patients compared with invasive BC overall (HR = 1.10, 95% confidence interval (CI) = 1.04–1.17), and lower compared with stage I BC without adjuvant systemic therapy (HR = 0.87; 95% CI = 0.82–0.92). In patients diagnosed ≥2011, the HR for invasive CBC was 1.38 (95% CI = 1.35–1.68) after screen-detected DCIS compared with screen-detected invasive BC, and was 2.14 (95% CI = 1.46–3.13) when not screen-detected. The C-index was 0.52 (95% CI = 0.50–0.54) for invasive CBC prediction in DCIS patients. In conclusion, CBC risks are low overall. DCIS patients had a slightly higher risk of invasive CBC compared with invasive BC, likely explained by the risk-reducing effect of (neo)adjuvant systemic therapy among BC patients. For support of clinical decision making more information is needed to differentiate CBC risks among DCIS patients.

Original language	English
Article number	60
Journal	npj Breast Cancer
Volume	6
Issue number	1
DOIs	https://doi.org/10.1038/s41523-020-00202-8
Publication status	Published - 1 Dec 2020

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Giardiello, D., Kramer, I., Hooning, M. J., Hauptmann, M., Lips, E. H., Sawyer, E., Thompson, A. M., de Munck, L., Siesling, S., Wesseling, J., Steyerberg, E. W., & Schmidt, M. K. (2020). Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer. npj Breast Cancer, 6(1), Article 60. https://doi.org/10.1038/s41523-020-00202-8

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title = "Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer",

abstract = "We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N = 28,003) or stage I–III BC (N = 275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, separate analyses were performed for stage I BC without adjuvant systemic therapy and by mode of first BC detection. Multivariable models including clinico-pathological and treatment data were created to assess CBC risk prediction performance in DCIS patients. The 10-year cumulative incidence of invasive CBC was 4.8% for DCIS patients (CBC = 1334). Invasive CBC risk was higher in DCIS patients compared with invasive BC overall (HR = 1.10, 95% confidence interval (CI) = 1.04–1.17), and lower compared with stage I BC without adjuvant systemic therapy (HR = 0.87; 95% CI = 0.82–0.92). In patients diagnosed ≥2011, the HR for invasive CBC was 1.38 (95% CI = 1.35–1.68) after screen-detected DCIS compared with screen-detected invasive BC, and was 2.14 (95% CI = 1.46–3.13) when not screen-detected. The C-index was 0.52 (95% CI = 0.50–0.54) for invasive CBC prediction in DCIS patients. In conclusion, CBC risks are low overall. DCIS patients had a slightly higher risk of invasive CBC compared with invasive BC, likely explained by the risk-reducing effect of (neo)adjuvant systemic therapy among BC patients. For support of clinical decision making more information is needed to differentiate CBC risks among DCIS patients.",

author = "Daniele Giardiello and Iris Kramer and Hooning, {Maartje J.} and Michael Hauptmann and Lips, {Esther H.} and Elinor Sawyer and Thompson, {Alastair M.} and {de Munck}, Linda and Sabine Siesling and Jelle Wesseling and Steyerberg, {Ewout W.} and Schmidt, {Marjanka K.}",

year = "2020",

month = dec,

day = "1",

doi = "10.1038/s41523-020-00202-8",

language = "English",

volume = "6",

journal = "npj Breast Cancer",

publisher = "Nature Publishing Group",

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T1 - Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer

AU - Giardiello, Daniele

AU - Kramer, Iris

AU - Hooning, Maartje J.

AU - Hauptmann, Michael

AU - Lips, Esther H.

AU - Sawyer, Elinor

AU - Thompson, Alastair M.

AU - de Munck, Linda

AU - Siesling, Sabine

AU - Wesseling, Jelle

AU - Steyerberg, Ewout W.

AU - Schmidt, Marjanka K.

PY - 2020/12/1

Y1 - 2020/12/1

N2 - We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N = 28,003) or stage I–III BC (N = 275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, separate analyses were performed for stage I BC without adjuvant systemic therapy and by mode of first BC detection. Multivariable models including clinico-pathological and treatment data were created to assess CBC risk prediction performance in DCIS patients. The 10-year cumulative incidence of invasive CBC was 4.8% for DCIS patients (CBC = 1334). Invasive CBC risk was higher in DCIS patients compared with invasive BC overall (HR = 1.10, 95% confidence interval (CI) = 1.04–1.17), and lower compared with stage I BC without adjuvant systemic therapy (HR = 0.87; 95% CI = 0.82–0.92). In patients diagnosed ≥2011, the HR for invasive CBC was 1.38 (95% CI = 1.35–1.68) after screen-detected DCIS compared with screen-detected invasive BC, and was 2.14 (95% CI = 1.46–3.13) when not screen-detected. The C-index was 0.52 (95% CI = 0.50–0.54) for invasive CBC prediction in DCIS patients. In conclusion, CBC risks are low overall. DCIS patients had a slightly higher risk of invasive CBC compared with invasive BC, likely explained by the risk-reducing effect of (neo)adjuvant systemic therapy among BC patients. For support of clinical decision making more information is needed to differentiate CBC risks among DCIS patients.

AB - We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N = 28,003) or stage I–III BC (N = 275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, separate analyses were performed for stage I BC without adjuvant systemic therapy and by mode of first BC detection. Multivariable models including clinico-pathological and treatment data were created to assess CBC risk prediction performance in DCIS patients. The 10-year cumulative incidence of invasive CBC was 4.8% for DCIS patients (CBC = 1334). Invasive CBC risk was higher in DCIS patients compared with invasive BC overall (HR = 1.10, 95% confidence interval (CI) = 1.04–1.17), and lower compared with stage I BC without adjuvant systemic therapy (HR = 0.87; 95% CI = 0.82–0.92). In patients diagnosed ≥2011, the HR for invasive CBC was 1.38 (95% CI = 1.35–1.68) after screen-detected DCIS compared with screen-detected invasive BC, and was 2.14 (95% CI = 1.46–3.13) when not screen-detected. The C-index was 0.52 (95% CI = 0.50–0.54) for invasive CBC prediction in DCIS patients. In conclusion, CBC risks are low overall. DCIS patients had a slightly higher risk of invasive CBC compared with invasive BC, likely explained by the risk-reducing effect of (neo)adjuvant systemic therapy among BC patients. For support of clinical decision making more information is needed to differentiate CBC risks among DCIS patients.

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U2 - 10.1038/s41523-020-00202-8

DO - 10.1038/s41523-020-00202-8

M3 - Article

AN - SCOPUS:85094964149

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JO - npj Breast Cancer

JF - npj Breast Cancer

IS - 1

M1 - 60

ER -

Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer

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