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

Alastair Thompson; Karen Clements; Shan Cheung; Sarah E. Pinder; Gill Lawrence; Elinor Sawyer; Olive Kearins; Graham R. Ball; Ian Tomlinson; Andrew Hanby; Jeremy St J. Thomas; Anthony J. Maxwell; Matthew Wallis; David J. Dodwell; Alastair Thompson; Adele Francis; Mark Sibbering; Hugh Bishop; Robert Carpenter; W.D. George; Martin Lee; Stewart Nicholson; Hilary Dobson; Andy Evans; Anthony Maxwell; Matthew Wallis; David Dodwell; Julian Adlard; John Dewar; Gillian Ross; Maggie Wilcox; Sarah E. Pinder; Valerie Speirs; Jeremy Thomas; Ian Ellis; Sunil Lakhani; James Macartney; Graham Ball; Bridget Hilton; Margot Wheaton

doi:10.1016/j.ejca.2018.06.027

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

Alastair Thompson, Karen Clements, Shan Cheung, Sarah E. Pinder, Gill Lawrence, Elinor Sawyer, Olive Kearins, Graham R. Ball, Ian Tomlinson, Andrew Hanby, Jeremy St J. Thomas, Anthony J. Maxwell, Matthew Wallis, David J. Dodwell, Alastair Thompson, Adele Francis, Mark Sibbering, Hugh Bishop, Robert Carpenter, W.D. GeorgeMartin Lee, Stewart Nicholson, Hilary Dobson, Andy Evans, Anthony Maxwell, Matthew Wallis, David Dodwell, Julian Adlard, John Dewar, Gillian Ross, Maggie Wilcox, Sarah E. Pinder, Valerie Speirs, Jeremy Thomas, Ian Ellis, Sunil Lakhani, James Macartney, Graham Ball, Bridget Hilton, Margot Wheaton

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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.

Original language	English
Pages (from-to)	210-219
Number of pages	10
Journal	European Journal of Cancer
Volume	101
Early online date	6 Aug 2018
DOIs	https://doi.org/10.1016/j.ejca.2018.06.027
Publication status	Published - Sept 2018

Keywords

Ductal carcinoma in situ
Radiotherapy
Margins
Recurrence

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ejca.2018.06.027

Management and 5-year outcomes_THOMPSON_Accepted19June2018_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 2.49 MBLicence: CC BY-NC-ND

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Thompson, A., Clements, K., Cheung, S., Pinder, S. E., Lawrence, G., Sawyer, E., Kearins, O., Ball, G. R., Tomlinson, I., Hanby, A., Thomas, J. S. J., Maxwell, A. J., Wallis, M., Dodwell, D. J., Thompson, A., Francis, A., Sibbering, M., Bishop, H., Carpenter, R., ... Wheaton, M. (2018). Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project. European Journal of Cancer, 101, 210-219. https://doi.org/10.1016/j.ejca.2018.06.027

@article{30b5ae5c93e045c7a9be2d8fab59f19d,

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

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.",

keywords = "Ductal carcinoma in situ, Radiotherapy, Margins, Recurrence",

author = "Alastair Thompson and Karen Clements and Shan Cheung and Pinder, {Sarah E.} and Gill Lawrence and Elinor Sawyer and Olive Kearins and Ball, {Graham R.} and Ian Tomlinson and Andrew Hanby and Thomas, {Jeremy St J.} and Maxwell, {Anthony J.} and Matthew Wallis and Dodwell, {David J.} and Alastair Thompson and Adele Francis and Mark Sibbering and Hugh Bishop and Robert Carpenter and W.D. George and Martin Lee and Stewart Nicholson and Hilary Dobson and Andy Evans and Anthony Maxwell and Matthew Wallis and David Dodwell and Julian Adlard and John Dewar and Gillian Ross and Maggie Wilcox and Pinder, {Sarah E.} and Valerie Speirs and Jeremy Thomas and Ian Ellis and Sunil Lakhani and James Macartney and Graham Ball and Bridget Hilton and Margot Wheaton",

year = "2018",

month = sep,

doi = "10.1016/j.ejca.2018.06.027",

language = "English",

volume = "101",

pages = "210--219",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "Elsevier Limited",

}

Thompson, A, Clements, K, Cheung, S, Pinder, SE, Lawrence, G, Sawyer, E, Kearins, O, Ball, GR, Tomlinson, I, Hanby, A, Thomas, JSJ, Maxwell, AJ, Wallis, M, Dodwell, DJ, Thompson, A, Francis, A, Sibbering, M, Bishop, H, Carpenter, R, George, WD, Lee, M, Nicholson, S, Dobson, H, Evans, A, Maxwell, A, Wallis, M, Dodwell, D, Adlard, J, Dewar, J, Ross, G, Wilcox, M, Pinder, SE, Speirs, V, Thomas, J, Ellis, I, Lakhani, S, Macartney, J, Ball, G, Hilton, B & Wheaton, M 2018, 'Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project', European Journal of Cancer, vol. 101, pp. 210-219. https://doi.org/10.1016/j.ejca.2018.06.027

TY - JOUR

T1 - Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

AU - Thompson, Alastair

AU - Clements, Karen

AU - Cheung, Shan

AU - Pinder, Sarah E.

AU - Lawrence, Gill

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

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 - Maxwell, Anthony

AU - Wallis, Matthew

AU - Dodwell, David

AU - Adlard, Julian

AU - Dewar, John

AU - Ross, Gillian

AU - Wilcox, Maggie

AU - Pinder, Sarah E.

AU - Speirs, Valerie

AU - Thomas, Jeremy

AU - Ellis, Ian

AU - Lakhani, Sunil

AU - Macartney, James

AU - Ball, Graham

AU - Hilton, Bridget

AU - Wheaton, Margot

PY - 2018/9

Y1 - 2018/9

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 - Radiotherapy

KW - Margins

KW - Recurrence

U2 - 10.1016/j.ejca.2018.06.027

DO - 10.1016/j.ejca.2018.06.027

M3 - Article

SN - 0959-8049

VL - 101

SP - 210

EP - 219

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

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

Abstract

Keywords

UN SDGs

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