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Characterization and Treatment of Local Recurrence Following Breast Conservation for Ductal Carcinoma In Situ

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The optimal treatment strategy for ductal carcinoma in situ (DCIS) continues to evolve and should consider the consequences of initial treatment on the likelihood, type, and treatment of recurrences.

Methods

We conducted a retrospective cohort study using two data sources of patients who experienced a recurrence (DCIS or invasive cancer) following breast-conserving surgery (BCS) for index DCIS: patients with an index DCIS diagnosed from 1997 to 2008 at the academic institutions of the National Comprehensive Cancer Network (NCCN; N = 88) and patients with an index DCIS diagnosed from 1990 to 2001 at community-based integrated healthcare delivery sites of the Health Maintenance Organization Cancer Research Network (CRN) (N = 182).

Results

Just under half of local recurrences in both cohorts were invasive cancer. While 40 % of patients in both cohorts underwent mastectomy alone at recurrence, treatment of the remaining patients varied. In the earlier CRN cohort, most other patients underwent repeat BCS (39 %) with only 18 % receiving mastectomy with reconstruction, whereas only 16 % had repeat BCS and 44 % had mastectomy with reconstruction in the NCCN cohort. Compared with patients not treated with radiation, those who received radiation for index DCIS were less likely to undergo repeat BCS (NCCN: 6.6 vs. 37 %, p = 0.001; CRN: 20 vs. 48 %, p = 0.0004) and more likely to experience surgical complications after treatment of recurrence (NCCN: 15 vs. 4 %, p = 0.17; CRN: 40 vs. 25 %, p = 0.09).

Conclusion

We found that treatment of recurrences after BCS and subsequent complications may be affected by the use of radiotherapy for the index DCIS. Initial treatment of DCIS may have long-term implications that should be considered.

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Acknowledgment

This work was supported by Contract No. HHSA29020050016I from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, as part of the Developing Evidence to Inform Decisions About Effectiveness program. The views expressed in this article are those of the authors, and no official endorsement by AHRQ or the US Department of Health and Human Services is intended or should be inferred. This work was also supported by grant no. CA89393 from the National Cancer Institute to the Dana-Farber Cancer Institute, Grant No. R01 CA 81302 to Kaiser Permanente Northern California, and grant no. 2U19CA079689 to Group Health Cooperative (Laurel Habel, Project Leader).

Conflict of interest

Caprice C. Greenberg, Laurel A. Habel, Melissa E. Hughes, Larissa Nekhlyudov, Ninah Achacoso, Luana Acton, Deborah Schrag, Wei Jiang, Stephen Edge, Jane C. Weeks, and Rinaa S. Punglia have no financial disclosures or conflicts of interest to disclose.

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Authors and Affiliations

  1. Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA

    Caprice C. Greenberg MD MPH

  2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Laurel A. Habel PhD, Ninah Achacoso MS & Luana Acton

  3. Division of Population Sciences, Department of Medical Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA

    Melissa E. Hughes MSc, Deborah Schrag MD & Jane C. Weeks MD MSc

  4. Department of Population Medicine, Harvard Medical School, Boston, MA, USA

    Larissa Nekhlyudov MD MPH

  5. Department of Medicine, Harvard Vanguard Medical Associates, Boston, MA, USA

    Larissa Nekhlyudov MD MPH

  6. Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Wei Jiang MSc

  7. Baptist Cancer Center, Baptist Memorial Health Care Corporation, Memphis, TN, USA

    Stephen Edge MD

  8. Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA

    Stephen Edge MD

  9. Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Rinaa S. Punglia MD MPH

Authors
  1. Caprice C. Greenberg MD MPH
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  2. Laurel A. Habel PhD
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  3. Melissa E. Hughes MSc
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  4. Larissa Nekhlyudov MD MPH
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  5. Ninah Achacoso MS
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  6. Luana Acton
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  7. Deborah Schrag MD
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  8. Wei Jiang MSc
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  9. Stephen Edge MD
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  10. Jane C. Weeks MD MSc
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  11. Rinaa S. Punglia MD MPH
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Corresponding author

Correspondence to Caprice C. Greenberg MD MPH.

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Greenberg, C.C., Habel, L.A., Hughes, M.E. et al. Characterization and Treatment of Local Recurrence Following Breast Conservation for Ductal Carcinoma In Situ. Ann Surg Oncol 21, 3766–3773 (2014). https://doi.org/10.1245/s10434-014-3802-7

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  • DOI: https://doi.org/10.1245/s10434-014-3802-7

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