A comparison of the risks of in-breast recurrence after a diagnosis of DCIS or early invasive breast cancer

S.A. Narod, E. Rakovitch

Abstract


Background

It is controversial whether ductal carcinoma in situ (dcis) is a preinvasive marker of breast cancer or if it is part of a spectrum of small cancers with malignant potential. Comparing clinical outcomes in women with invasive and noninvasive breast lesions might help to resolve the issue.

Methods

From a database of 2641 patients with breast cancer, we selected women who had been treated with breastconserving surgery for a cancer that was 2.0 cm or less in size, node-negative, and nonpalpable. No subject received chemotherapy. Cancers were categorized as noninvasive (stage 0, n = 172) or invasive (stage 1, n = 401) based on a review of the pathology records. We compared the actuarial risks of in-breast recurrence after invasive and noninvasive breast lesions before and after adjusting for tamoxifen and radiotherapy.

Results

The 18-year cumulative risk of in-breast recurrence was 35.2% for patients with dcis and 12.8% for patients with small invasive cancers (hazard ratio: 2.4; 95% confidence interval: 1.5 to 3.8; p < 0.0003). After adjustment for radiotherapy and tamoxifen treatment, the difference was small and nonsignificant (hazard ratio: 1.4; 95% confidence interval: 0.9 to 2.4; p = 0.22).

Conclusions

For women with small, nonpalpable, node-negative breast cancers, the likelihood of experiencing an inbreast recurrence was associated with radiotherapy and with tamoxifen, but not with the presence of cancer cells invading beyond the basement membrane.


Keywords


Breast cancer; dcis prognostic factors; recurrence

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DOI: http://dx.doi.org/10.3747/co.21.1892






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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)