Skip to main content

Advertisement

SpringerLink
Log in

Ductal carcinoma in situ in patients younger than 30 years: differences in adjuvant endocrine therapy and outcomes

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

Abstract

Purpose

To use the National Cancer Database to assess treatment patterns in very young women with ductal carcinoma in situ (DCIS) given their propensity for higher risk features and increased risk of recurrence.

Methods

We used the NCDB to identify female patients who underwent surgery for a first cancer diagnosis of DCIS within three different age groups: ≤30, 31–50, and >50. Demographic information, tumor characteristics, and initial treatment patterns were characterized and compared. Univariable and multivariable logistic regression of individuals with hormone-receptor-positive disease who underwent breast-conserving surgery (BCS) was conducted to assess for group differences in adjuvant endocrine therapy utilization. Survival analysis was conducted via Kaplan-Meier method and Cox regression.

Results

We identified 236,832 patients meeting inclusion criteria. Individuals in the youngest group were more likely to be a minority, had better Charlson-Deyo scores, lived further from their treatment facility, and were less often insured. This group also had more unfavorable tumor features and were more likely to undergo bilateral mastectomy. In subgroup analysis of patients with hormone-receptor-positive disease who underwent BCS, the youngest group was significantly less likely to have received endocrine therapy. There was also a trend toward worse overall survival in the youngest group.

Conclusion

We report differences in demographics, tumor characteristics, and treatment of very young women with DCIS. Given the known reduction in recurrence with use of adjuvant endocrine therapy, there may be room for increasing therapy rates or otherwise altering guidelines for treatment of young women with hormone-receptor-positive DCIS who undergo BCS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Use

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

References

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

    Article  PubMed  Google Scholar 

  2. Jones CE, Richman J, Jackson BE et al (2018) Treatment patterns for ductal carcinoma in situ with close or positive mastectomy margins. J Surg Res 231:36–42. https://doi.org/10.1016/j.jss.2018.05.007

    Article  PubMed  Google Scholar 

  3. Sagara Y, Freedman RA, Wong SM et al (2017) Trends in adjuvant therapies after breast-conserving surgery for hormone receptor-positive ductal carcinoma in situ: findings from the National Cancer Database, 2004–2013. Breast Cancer Res Treat 166:583–592. https://doi.org/10.1007/s10549-017-4436-9

    Article  PubMed  Google Scholar 

  4. Van Bockstal MR, Agahozo MC, Koppert LB, van Deurzen CHM (2020) A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast. Int J Cancer 146:1189–1197. https://doi.org/10.1002/ijc.32362

    Article  CAS  PubMed  Google Scholar 

  5. Nguyen TT, Hoskin TL, Day CN et al (2017) Factors influencing use of hormone therapy for ductal carcinoma in situ: a National Cancer Database Study. Ann Surg Oncol 24:2989–2998. https://doi.org/10.1245/s10434-017-5930-3

    Article  PubMed  Google Scholar 

  6. Nassar H, Sharafaldeen B, Visvanathan K, Visscher D (2009) Ductal carcinoma in situ in African American versus Caucasian American women: analysis of clinicopathologic features and outcome. Cancer 115:3181–3188. https://doi.org/10.1002/cncr.24376

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ward EP, Unkart JT, Bryant A et al (2017) Influence of distance to hospital and insurance status on the rates of contralateral prophylactic mastectomy, a National Cancer Data Base study. Ann Surg Oncol 24:3038–3047. https://doi.org/10.1245/s10434-017-5985-1

    Article  PubMed  Google Scholar 

  8. Cronin PA, Olcese C, Patil S et al (2016) Impact of age on risk of recurrence of ductal carcinoma in situ: outcomes of 2996 women treated with breast-conserving surgery over 30 years. Ann Surg Oncol 23:2816–2824. https://doi.org/10.1245/s10434-016-5249-5

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vicini FA, Kestin LL, Goldstein NS et al (2000) Impact of young age on outcome in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J Clin Oncol Off J Am Soc Clin Oncol 18:296–306. https://doi.org/10.1200/JCO.2000.18.2.296

    Article  CAS  Google Scholar 

  10. Alvarado R, Lari SA, Roses RE et al (2012) Biology, treatment, and outcome in very young and older women with DCIS. Ann Surg Oncol 19. https://doi.org/10.1245/s10434-012-2413-4

  11. Xiong Q, Valero V, Kau V et al (2001) Female patients with breast carcinoma age 30 years and younger have a poor prognosis. Cancer 92:2523–2528. https://doi.org/10.1002/1097-0142(20011115)92:10<2523::AID-CNCR1603>3.0.CO;2-6

    Article  CAS  PubMed  Google Scholar 

  12. Francis PA (2011) Optimal adjuvant therapy for very young breast cancer patients. Breast 20:297–302. https://doi.org/10.1016/j.breast.2011.05.002

    Article  PubMed  Google Scholar 

  13. Park HL, Chang J, Lal G et al (2018) Trends in treatment patterns and clinical outcomes in young women diagnosed with ductal carcinoma in situ. Clin Breast Cancer 18:e179–e185. https://doi.org/10.1016/j.clbc.2017.08.001

    Article  PubMed  Google Scholar 

  14. Llarena NC, Estevez SL, Tucker SL, Jeruss JS (2015) Impact of fertility concerns on Tamoxifen initiation and persistence. J Natl Cancer Inst 107. https://doi.org/10.1093/jnci/djv202

  15. Voci A, Bandera B, Ho E et al (2018) Variations in cancer care for adolescents and young adults (AYAs) with ductal carcinoma in situ. Breast J 24:555–560. https://doi.org/10.1111/tbj.12999

    Article  CAS  PubMed  Google Scholar 

  16. Boffa DJ, Rosen JE, Mallin K et al (2017) Using the national cancer database for outcomes research: a review. JAMA Oncol 3:1722–1728. https://doi.org/10.1001/jamaoncol.2016.6905

    Article  PubMed  Google Scholar 

  17. Parsons BM, Landercasper J, Smith AL et al (2016) 21-gene recurrence score decreases receipt of chemotherapy in ER+ early-stage breast cancer: an analysis of the NCDB 2010–2013. Breast Cancer Res Treat 159:315–326. https://doi.org/10.1007/s10549-016-3926-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Allred DC, Anderson SJ, Paik S et al (2012) Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol Off J Am Soc Clin Oncol 30:1268–1273. https://doi.org/10.1200/JCO.2010.34.0141

    Article  CAS  Google Scholar 

  19. Kauffmann RM, Goldstein L, Marcinkowski E et al (2016) Predictors of Antiestrogen recommendation in women with Estrogen receptor-positive ductal carcinoma in situ. J Natl Compr Cancer Netw 14:1081–1090. https://doi.org/10.6004/jnccn.2016.0118

    Article  CAS  Google Scholar 

  20. Gnerlich JL, Deshpande AD, Jeffe DB et al (2009) Elevated breast cancer mortality in young women (<40 years) compared with older women is attributed to poorer survival in early stage disease. J Am Coll Surg 208:341–347. https://doi.org/10.1016/j.jamcollsurg.2008.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fredholm H, Eaker S, Frisell J et al (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS One 4. https://doi.org/10.1371/journal.pone.0007695

  22. Virnig BA, Torchia MT, Jarosek SL et al (2011) Use of endocrine therapy following diagnosis of ductal carcinoma in situ or early invasive breast cancer: data points # 14, Data points publication series. Agency for Healthcare Research and Quality (US), Rockville

    Google Scholar 

  23. DeCensi A, Puntoni M, Guerrieri-Gonzaga A et al (2019) Randomized placebo controlled trial of low-dose Tamoxifen to prevent local and contralateral recurrence in breast intraepithelial Neoplasia. J Clin Oncol 37:1629–1637. https://doi.org/10.1200/JCO.18.01779

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was funded by the National Cancer Institute of the National Institutes of Health under Award Number T32CA121938 and the Academic Senate of UC San Diego. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Surgery, University of California San Diego, 9300 Campus Point Drive, #7220, La Jolla, CA, 92037, USA

    Sasha R. Halasz & Thomas O’Keefe

  2. Division of Breast Surgery and The Comprehensive Breast Health Center, University of California San Diego, Mailbox 0819, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA

    Anne M. Wallace & Sarah L. Blair

Authors
  1. Sasha R. Halasz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas O’Keefe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne M. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah L. Blair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah L. Blair.

Ethics declarations

Conflict of interest

Sasha Halasz declares that she has no conflict of interest. Thomas O’Keefe declares that he has no conflict of interest. Anne Wallace declares that she has no conflict of interest. SLB has a family member with an equity interest in Viewpoint Medical, Inc., a company that has no benefit from the research results.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. The UCSD HRPP/IRB deferred need for approval due to use of public, de-identified data.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This is an invited commentary to article doi: 10.1007/s10549-020-06014-5.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Halasz, S.R., O’Keefe, T., Wallace, A.M. et al. Ductal carcinoma in situ in patients younger than 30 years: differences in adjuvant endocrine therapy and outcomes. Breast Cancer Res Treat 186, 551–559 (2021). https://doi.org/10.1007/s10549-020-06014-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-020-06014-5

Keywords

Search

Navigation