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Association of lifestyle and clinical characteristics with receipt of radiotherapy treatment among women diagnosed with DCIS in the NIH-AARP Diet and Health Study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

The long-term risks and benefits of radiotherapy for ductal carcinoma in situ (DCIS) remain unclear. Recent data from the Surveillance, Epidemiology and End Results (SEER) registries showed that DCIS-associated radiotherapy treatment significantly increased risk of second non-breast cancers including lung cancer. To help understand those observations and whether breast cancer risk factors are related to radiotherapy treatment decision-making, we examined associations between lifestyle and clinical factors with DCIS radiotherapy receipt.

Methods

Among 1628 participants from the NIH-AARP Diet and Health Study, diagnosed with incident DCIS (1995–2011), we examined associations between lifestyle and clinical factors with radiotherapy receipt. Radiotherapy and clinical information were ascertained from state cancer registries. Odds ratios (ORs) and 95% confidence intervals (CIs) for radiotherapy receipt (yes/no) were estimated from multivariable logistic regression.

Results

Overall, 45% (n = 730) received radiotherapy. No relationships were observed for most lifestyle factors and radiotherapy receipt, including current smoking (OR 0.97, 95%CI 0.70, 1.34). However positive associations were observed for moderate alcohol consumption and infrequent physical activity. The strongest associations were observed for radiotherapy receipt and more recent diagnoses (2005–2011 vs. 1995–1999; OR 1.60, 95%CI 1.14, 2.25), poorly versus well-differentiated tumors (OR 1.69, 95%CI 1.16, 2.46) and endocrine therapy (OR 3.37, 95%CI 2.56, 4.44).

Conclusions

Clinical characteristics were the strongest determinants of DCIS radiotherapy. Receipt was largely unrelated to lifestyle factors suggesting that the previously observed associations in SEER were likely not confounded by these lifestyle factors. Further studies are needed to understand mechanisms driving radiotherapy-associated second malignancies following DCIS, to identify prevention opportunities for this growing population.

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Fig. 1

*There were an additional n = 23 women with missing chemotherapy information. These were assumed not to be treated with chemotherapy and therefore not excluded from the analysis

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Data availability

The datasets analyzed during the current study were obtained from the National Cancer Institute. The data used in the present study are available following the submission of a proposal and upon approval from the NIH-AARP Steering Committee (https://dietandhealth.cancer.gov/). Researchers can access data from the NIH-AARP Diet and Health Study (https://dietandhealth.cancer.gov/) in the same manner as the authors.

Abbreviations

ANOVA:

Analysis of variance analysis

AARP:

Formerly American Association of Retired Persons

CI:

Confidence interval

DCIS:

Ductal carcinoma in situ

NIH:

National Institutes of Health

OR:

Odds ratios

SEER:

Surveillance, Epidemiology and End Results

US:

United States

References

  1. Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KAe SEER Cancer statistics review, 1975–2015, National Cancer Institute, Bethesda. https://www.seercancergov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018

  2. Ward EM, DeSantis CE, Lin CC, Kramer JL, Jemal A, Kohler B, Brawley OW, Gansler T (2015) Cancer statistics: breast cancer in situ. CA Cancer J Clin 65(6):481–495. https://doi.org/10.3322/caac.21321

    Article  PubMed  Google Scholar 

  3. Kerlikowske K (2010) Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr 2010(41):139–141. https://doi.org/10.1093/jncimonographs/lgq027

    Article  PubMed  PubMed Central  Google Scholar 

  4. Baxter NN, Virnig BA, Durham SB, Tuttle TM (2004) Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 96(6):443–448

    Article  Google Scholar 

  5. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, Elias AD, Farrar WB, Forero A, Giordano SH, Goetz MP, Goldstein LJ, Isakoff SJ, Lyons J, Marcom PK, Mayer IA, McCormick B, Moran MS, O’Regan RM, Patel SA, Pierce LJ, Reed EC, Salerno KE, Schwartzberg LS, Sitapati A, Smith KL, Smith ML, Soliman H, Somlo G, Telli ML, Ward JH, Kumar R, Shead DA (2018) Breast cancer, Version 4.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 16(3):310–320. https://doi.org/10.6004/jnccn.2018.0012

    Article  Google Scholar 

  6. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, Horton J, Hwang S, Johnson PL, Marinovich ML, Schnitt SJ, Wapnir I, Moran MS (2016) Society of surgical oncology-American society for radiation oncology-American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol 34(33):4040–4046. https://doi.org/10.1200/JCO.2016.68.3573

    Article  PubMed  PubMed Central  Google Scholar 

  7. Early Breast Cancer Trialists’ Collaborative Group, Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, Peto R, Bijker N, Solin L, Darby S (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 41:162–177. https://doi.org/10.1093/jncimonographs/lgq039

    Article  Google Scholar 

  8. Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P (2015) Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol 1(7):888–896. https://doi.org/10.1001/jamaoncol.2015.2510

    Article  PubMed  Google Scholar 

  9. Corradini S, Pazos M, Schonecker S, Reitz D, Niyazi M, Ganswindt U, Schrodi S, Braun M, Polcher M, Mahner S, Harbeck N, Engel J, Belka C (2018) Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases. Radiat Oncol 13(1):25. https://doi.org/10.1186/s13014-018-0964-7

    Article  PubMed  PubMed Central  Google Scholar 

  10. Withrow DR, Morton LM, Curtis RE, Schonfeld SJ, Berrington de Gonzalez A (2017) Radiotherapy for ductal carcinoma in situ and risk of second non-breast cancers. Breast Cancer Res Treat 166(1):299–306. https://doi.org/10.1007/s10549-017-4410-6

    Article  PubMed  Google Scholar 

  11. Schatzkin A, Subar AF, Thompson FE, Harlan LC, Tangrea J, Hollenbeck AR, Hurwitz PE, Coyle L, Schussler N, Michaud DS, Freedman LS, Brown CC, Midthune D, Kipnis V (2001) Design and serendipity in establishing a large cohort with wide dietary intake distributions: the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Am J Epidemiol 154(12):1119–1125

    Article  CAS  Google Scholar 

  12. DiMarzio P, Peila R, Dowling O, Timony DM, Balgobind A, Lee LN, Kostroff KM, Ho GYF (2018) Smoking and alcohol drinking effect on radiotherapy associated risk of second primary cancer and mortality among breast cancer patients. Cancer Epidemiol 57:97–103. https://doi.org/10.1016/j.canep.2018.10.002

    Article  PubMed  Google Scholar 

  13. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R (2000) Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med 160(7):953–958

    Article  CAS  Google Scholar 

  14. Zhang S, Liu Y, Yun S, Lian M, Komaie G, Colditz GA (2018) Impacts of neighborhood characteristics on treatment and outcomes in women with ductal carcinoma in situ of the breast. Cancer Epidemiol Biomark Prev 27(11):1298–1306. https://doi.org/10.1158/1055-9965.EPI-17-1102

    Article  Google Scholar 

  15. Shumway DA, Griffith KA, Hawley ST, Wallner LP, Ward KC, Hamilton AS, Morrow M, Katz SJ, Jagsi R (2018) Patient views and correlates of radiotherapy omission in a population-based sample of older women with favorable-prognosis breast cancer. Cancer 124(13):2714–2723. https://doi.org/10.1002/cncr.31378

    Article  PubMed  Google Scholar 

  16. Shumway DA, McLeod CM, Morrow M, Li Y, Kurian AW, Sabolch A, Hamilton AS, Ward KC, Katz SJ, Hawley ST, Jagsi R (2018) Patient experiences and clinician views on the role of radiation therapy for ductal carcinoma in situ. Int J Radiat Oncol Biol Phys 100(5):1237–1245. https://doi.org/10.1016/j.ijrobp.2018.01.020

    Article  PubMed  Google Scholar 

  17. Martinez-Perez C, Turnbull AK, Ekatah GE, Arthur LM, Sims AH, Thomas JS, Dixon JM (2017) Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast. Cancer Treat Rev 55:163–172. https://doi.org/10.1016/j.ctrv.2017.03.009

    Article  PubMed  Google Scholar 

  18. Lin CY, Mooney K, Choy W, Yang SR, Barry-Holson K, Horst K, Wapnir I, Allison K (2018) Will oncotype DX DCIS testing guide therapy? A single-institution correlation of oncotype DX DCIS results with histopathologic findings and clinical management decisions. Mod Pathol 31(4):562–568. https://doi.org/10.1038/modpathol.2017.172

    Article  CAS  PubMed  Google Scholar 

  19. Manders JB, Kuerer HM, Smith BD, McCluskey C, Farrar WB, Frazier TG, Li L, Leonard CE, Carter DL, Chawla S, Medeiros LE, Guenther JM, Castellini LE, Buchholz DJ, Mamounas EP, Wapnir IL, Horst KC, Chagpar A, Evans SB, Riker AI, Vali FS, Solin LJ, Jablon L, Recht A, Sharma R, Lu R, Sing AP, Hwang ES, White J, Study i, study p (2017) Clinical Utility of the 12-gene DCIS score assay: impact on radiotherapy recommendations for patients with ductal carcinoma in situ. Ann Surg Oncol 24(3):660–668. https://doi.org/10.1245/s10434-016-5583-7

    Article  PubMed  Google Scholar 

  20. Dilaveri CA, Sandhu NP, Neal L, Neben-Wittich MA, Hieken TJ, Mac Bride MB, Wahner-Roedler DL, Ghosh K (2014) Medical factors influencing decision making regarding radiation therapy for breast cancer. Int J Womens Health 6:945–954. https://doi.org/10.2147/IJWH.S71591

    Article  PubMed  PubMed Central  Google Scholar 

  21. Noone AM, Lund JL, Mariotto A, Cronin K, McNeel T, Deapen D, Warren JL (2016) Comparison of SEER treatment data with medicare claims. Med Care 54(9):e55–64. https://doi.org/10.1097/MLR.0000000000000073

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research was supported [in part] by the Intramural Research Program of the NIH, National Cancer Institute. Cancer incidence data from the Atlanta metropolitan area were collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. Cancer incidence data from California were collected by the California Cancer Registry, California Department of Public Health’s Cancer Surveillance and Research Branch, Sacramento, California. Cancer incidence data from the Detroit metropolitan area were collected by the Michigan Cancer Surveillance Program, Community Health Administration, Lansing, Michigan. The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System (Miami, Florida) under contract with the Florida Department of Health, Tallahassee, Florida. The views expressed herein are solely those of the authors and do not necessarily reflect those of the FCDC or FDOH. Cancer incidence data from Louisiana were collected by the Louisiana Tumor Registry, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana. Cancer incidence data from New Jersey were collected by the New Jersey State Cancer Registry, The Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. Cancer incidence data from North Carolina were collected by the North Carolina Central Cancer Registry, Raleigh, North Carolina. Cancer incidence data from Pennsylvania were supplied by the Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. Cancer incidence data from Arizona were collected by the Arizona Cancer Registry, Division of Public Health Services, Arizona Department of Health Services, Phoenix, Arizona. Cancer incidence data from Texas were collected by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas. Cancer incidence data from Nevada were collected by the Nevada Central Cancer Registry, Division of Public and Behavioral Health, State of Nevada Department of Health and Human Services, Carson City, Nevada. We are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. We also thank Sigurd Hermansen and Kerry Grace Morrissey from Westat for study outcomes ascertainment and management and Leslie Carroll at Information Management Services for data support and analysis (https://dietandhealth.cancer.gov/acknowledgement.html).

Funding

This study was funded by the Intramural Research Program of the National Cancer Institute at the National Institutes of Health. MM was also funded in part by the Health Research Board in Ireland (Grant number: CPFPR-2013-1).

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Author notes

  1. Amy Berrington de González and Gretchen L. Gierach contributed equally as senior authors.

Authors and Affiliations

  1. Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland

    Maeve Mullooly

  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    Diana R. Withrow, Rochelle E. Curtis, Shaoqi Fan, Linda M. Liao, Ruth M. Pfeiffer, Amy Berrington de González & Gretchen L. Gierach

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Contributions

MM, DRW, ABdG and GLG conceived and designed the study. MM, RMP, SF and REC oversaw statistical analysis. MM, DRW, REC, LML contributed to the drafting of the results. All authors substantially contributed to the preparation and critical review of the manuscript.

Corresponding author

Correspondence to Maeve Mullooly.

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Conflict of interests

All authors declare that they have no conflict of interest.

Ethical approval

The Special Studies Institutional Review Board (SSIRB) of the U.S. National Cancer Institute approved the NIH-AARP Diet and Health Study (Protocol Number: OH95CN025). This study was conducted in accordance with the ethical standards of the aforementioned institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Completion of the self-administered questionnaire was considered to imply informed consent to participate in the study.

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Electronic supplementary material

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10549_2019_5436_MOESM1_ESM.xlsx

Supplementary Table 1A: Sensitivity analysis for associations of patient characteristics with radiotherapy treatment among DCIS patients diagnosed within 5 years of completing the baseline questionnaire, NIH-AARP Cohort Study (1995-2011). Supplementary material 1 (XLSX 24 kb)

10549_2019_5436_MOESM2_ESM.xlsx

Supplementary Table 1B: Sensitivity analysis for associations of patient characteristics with radiotherapy treatment among DCIS patients diagnosed during or after 2000, NIH-AARP Cohort Study (1995-2011). Supplementary material 2 (XLSX 24 kb)

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Mullooly, M., Withrow, D.R., Curtis, R.E. et al. Association of lifestyle and clinical characteristics with receipt of radiotherapy treatment among women diagnosed with DCIS in the NIH-AARP Diet and Health Study. Breast Cancer Res Treat 179, 445–457 (2020). https://doi.org/10.1007/s10549-019-05436-0

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