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

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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 & 20 more 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

Original languageEnglish
Pages (from-to)210-219
Number of pages10
JournalEuropean Journal of Cancer
Volume101
Early online date6 Aug 2018
DOIs
Publication statusPublished - Sep 2018

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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.

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