Association of DCIS Size and Margin Status With Risk of Developing Breast Cancer Post-Treatment: Multinational, Pooled Cohort Study

Authors

Renée S J M Schmitz
Alexandra W van den Belt-Dusebout
Karen Clements
Yi Ren
Chiara Cresta
Jasmine Timbres
Yat-Hee Liu
Danalyn Byng
Thomas Lynch
Brian A Menegaz
Deborah Collyar
Terry Hyslop
Samantha Thomas
Jason K Love
Michael Schaapveld
Proteeti Bhattacharjee
Marc D Ryser
Elinor Sawyer
E Shelley Hwang
Alastair Thompson
Jelle Wesseling
Esther H Lips
Marjanka K Schmidt

Publication Date

10-30-2023

Journal

BMJ

Abstract

OBJECTIVE: To examine the association between size and margin status of ductal carcinoma in situ (DCIS) and risk of developing ipsilateral invasive breast cancer and ipsilateral DCIS after treatment, and stage and subtype of ipsilateral invasive breast cancer.

DESIGN: Multinational, pooled cohort study.

SETTING: Four large international cohorts.

PARTICIPANTS: Patient level data on 47 695 women with a diagnosis of pure, primary DCIS between 1999 and 2017 in the Netherlands, UK, and US who underwent surgery, either breast conserving or mastectomy, often followed by radiotherapy or endocrine treatment, or both.

MAIN OUTCOME MEASURES: The main outcomes were 10 year cumulative incidence of ipsilateral invasive breast cancer and ipsilateral DCIS estimated in relation to DCIS size and margin status, and adjusted hazard ratios and 95% confidence intervals, estimated using multivariable Cox proportional hazards analyses with multiple imputed data RESULTS: The 10 year cumulative incidence of ipsilateral invasive breast cancer was 3.2%. In women who underwent breast conserving surgery with or without radiotherapy, only adjusted risks for ipsilateral DCIS were significantly increased for larger DCIS (20-49 mm) compared with DCIS(hazard ratio 1.38, 95% confidence interval 1.11 to 1.72). Risks for both ipsilateral invasive breast cancer and ipsilateral DCIS were significantly higher with involved compared with clear margins (invasive breast cancer 1.40, 1.07 to 1.83; DCIS 1.39, 1.04 to 1.87). Use of adjuvant endocrine treatment was not significantly associated with a lower risk of ipsilateral invasive breast cancer compared to treatment with breast conserving surgery only (0.86, 0.62 to 1.21). In women who received breast conserving treatment with or without radiotherapy, higher DCIS grade was not significantly associated with ipsilateral invasive breast cancer, only with a higher risk of ipsilateral DCIS (grade 1: 1.42, 1.08 to 1.87; grade 3: 2.17, 1.66 to 2.83). Higher age at diagnosis was associated with lower risk (per year) of ipsilateral DCIS (0.98, 0.97 to 0.99) but not ipsilateral invasive breast cancer (1.00, 0.99 to 1.00). Women with large DCIS (≥50 mm) more often developed stage III and IV ipsilateral invasive breast cancer compared to women with DCISfound.

CONCLUSIONS: The association of DCIS size and margin status with ipsilateral invasive breast cancer and ipsilateral DCIS was small. When these two factors were added to other known risk factors in multivariable models, clinicopathological risk factors alone were found to be limited in discriminating between low and high risk DCIS.

Keywords

Female, Humans, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Cohort Studies, Mastectomy, Mastectomy, Segmental, Risk Factors, Hormones, Neoplasm Recurrence, Local

Comments

Supplementary Materials

PMID: 37903527