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

• Published in: European journal of cancer (1990) Vol. 101; pp. 210 - 219
• Main Authors: Thompson, Alastair M., Clements, Karen, Cheung, Shan, Pinder, Sarah E., Lawrence, Gill, Sawyer, Elinor, Kearins, Olive, Ball, Graham R., Tomlinson, Ian, Hanby, Andrew, Thomas, Jeremy St J., Maxwell, Anthony J., Wallis, Matthew G., Dodwell, David J., Thompson, Alastair, Francis, Adele, Sibbering, Mark, Bishop, Hugh, Carpenter, Robert, George, W.D., Lee, Martin, Nicholson, Stewart, Dobson, Hilary, Evans, Andy, Maxwell, Anthony, Wallis, Matthew, Dodwell, David, Adlard, Julian, Dewar, John, Ross, Gillian, Wilcox, Maggie, Pinder, Sarah, Speirs, Valerie, Thomas, Jeremy, Ellis, Ian, Lakhani, Sunil, Macartney, James, Ball, Graham, Hilton, Bridget, Wheaton, Margot
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2018; Elsevier Science Ltd
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Biomarkers; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - therapy; Cancer; Cancer therapies; Carcinoma in Situ - diagnosis; Carcinoma in Situ - therapy; Carcinoma, Ductal, Breast - diagnosis; Carcinoma, Ductal, Breast - therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Confidence intervals; Disease management; Ductal carcinoma in situ; Endocrine therapy; Female; Health risks; Humans; Invasiveness; Margins; Mass Screening - methods; Mass Screening - statistics & numerical data; Mastectomy - methods; Mastectomy, Segmental - methods; Middle Aged; Mortality; Neoplasm Recurrence, Local; Prospective Studies; Radiation therapy; Radiotherapy; Radiotherapy - methods; Recurrence; Reduction; Surgery; Survival Analysis; Treatment Outcome; United Kingdom; United Kingdom; United Kingdom > UK; Recurrence; Margins; Ductal carcinoma in situ; Radiotherapy
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2018.06.027

Management of screen-detected ductal carcinoma in situ (DCIS) remains controversial. 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. 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. 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. •Adjuvant radiotherapy (RT) after wide excision is associated with a reduced risk of ipsilateral recurrence but not mortality•Survival after treatment of DCIS is excellent, with few subsequent deaths from breast cancer.•Further DCIS or invasive breast cancer is not uncommon (6.8% at 5 years)•5-year mortality was not impacted by the use of RT or endocrine therapy.