Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer (carcinoma) starts inside the milk ducts. In situ, which means "in its original place," means the non-invasive cancer hasn't spread beyond the milk duct. DCIS isn't life-threatening, but people diagnosed with DCIS are at risk of the DCIS coming back and are at higher-than-average risk of developing invasive breast cancer later on.
Lumpectomy (rather than mastectomy) followed by radiation therapy is the recommended treatment for most DCIS.
The study reviewed here found that younger women (under 45) who have lumpectomy and radiation therapy to treat DCIS were more likely to have the breast cancer come back (recurrence) compared to older women who had the same treatment. The results were presented at the 2009 ASCO Breast Cancer Symposium.
The researchers looked the medical records of 624 women diagnosed with DCIS and treated with lumpectomy and radiation therapy. After about 8 years of follow-up, the researchers found the following recurrence (either DCIS or invasive breast cancer) rates:
When the researchers accounted for differences in individual treatments (radiation dose, for example), they found:
compared to women older than 45. Despite the differences in recurrence risk, survival rates were similar for all three age groups. This means all the women had the same chance of being alive 5 years after diagnosis.
The researchers aren't sure why the younger women diagnosed with DCIS were more likely to have a recurrence after lumpectomy and radiation therapy. Research has shown that invasive breast cancer in younger women tends to be more aggressive than invasive breast cancer diagnosed in older women, which may be contributing to the results seen here. It's also possible that surgeons may be removing less tissue during lumpectomy in younger women to improve cosmetic results after surgery. This carries the risk that some cancer cells may be left behind unknowingly, which increases the risk of recurrence.
These results DON'T mean that younger women diagnosed with DCIS should choose mastectomy instead of lumpectomy and radiation therapy. Lumpectomy followed by radiation therapy is a good choice for these women. These findings do suggest:
Regardless of your age, if you've been diagnosed with DCIS, you and your doctor will work together to develop a treatment and follow-up plan that makes the most sense for your unique situation. If you're younger than 45, you might want to ask your doctor about this study.
You can find more information about DCIS in the Breastcancer.org Ductal Carcinoma in Situ pages.
SAN FRANCISCO (MedPage Today) -- Young women with ductal carcinoma in situ (DCIS) may get poorer outcomes with breast conserving surgery than older patients do, though survival is unaffected, researchers found.
Local recurrence rates after lumpectomy and radiation therapy were 64% to 83% higher for those diagnosed before age 45 than among older women, Iwa Kong, MD, of the Sunnybrook Odette Cancer Center in Toronto, and colleagues reported here at the ASCO Breast Cancer Symposium.
But Kong warned against taking the population-based study findings as support for universal mastectomy for younger women.
"This is really preliminary data, so this in no way suggests that young women cannot be treated safely with breast conserving surgery," she cautioned.
Even though recurrence rates rose with age, the absolute rates were still acceptably low for all groups, said discussant Lawrence J. Solin, MD, of Albert Einstein Medical Center in Philadelphia.
Overall survival rates were uniformly high at 97% to 99% at five years (P=NS).
Instead of serving to deny younger women less aggressive surgery, the results emphasize the importance of good clinical follow-up and that omission of radiation is not suitable for any subgroup of younger women, Solin said.
The researchers analyzed an administrative database of all women under age 50 diagnosed with DCIS from 1994 through 2003 in Ontario. Among the 1,659 women in this category, 624 received lumpectomy and radiation therapy as validated by chart review.
Few had high grade pathology (7%) or surgical margins that weren't positive (13%).
Across age ranges in the cohort, similar radiation doses (most commonly 5,000 cGy) and use of boost radiation therapy to the surgical cavity (about 30%) were seen.
But local recurrence rates did differ by age during the average 7.8 years of follow-up.
Any local recurrence -- DCIS or invasive -- was seen in 20% of those under age 40, in 19% of those 40 to 44, and in 12% of those 45 to 50.
After adjustment for boost radiation dose, nuclear grade, and year of diagnosis, the risk remained elevated for the younger age groups with a hazard ratio of 1.83 for those under age 40 (P=0.05) and 1.64 for those age 40 to 44 (P=0.03).
Local recurrence-free survival rates were highest for the oldest of the age groups (86% when diagnosed at age 45 to 50) but declined significantly with younger age (79% at 40 to 44, and 77% under 40, P=0.04).
However, the differences were not significant for invasive cancer recurrences alone.
Possible explanations for the differences in recurrence rates might be that younger women with DCIS are more likely to have BRCA mutations or biologically aggressive disease or that surgeons do a less thorough lumpectomy to improve cosmesis in younger women, Kong speculated.
But she acknowledged that the study was limited by lack of data on tamoxifen use and volume of tissue excised.
The study was supported by the Canadian Cancer Society Research Institute.
The researchers reported no conflicts of interest.
Solin reported no conflicts of interest.
Primary source: ASCO Breast Cancer Symposium Source reference: Kong I, et al "Outcomes of young women with DCIS treated with breast-conserving surgery and radiotherapy: A population-based analysis" ASCO Breast 2009; Abstract 127.
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