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. 2013 Mar 5;108(4):812-9.
doi: 10.1038/bjc.2013.26. Epub 2013 Jan 31.

Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study

L Holmberg  1 , Y N S Wong, L Tabár, A Ringberg, P Karlsson, L-G Arnesson, K Sandelin, H Anderson, H Garmo, S Emdin
Affiliations

Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study

L Holmberg et al. Br J Cancer. .

Abstract

Background: We studied the association between mammographic calcifications and local recurrence in the ipsilateral breast.

Methods: Case-cohort study within a randomised trial of radiotherapy in breast conservation for ductal cancer in situ of the breast (SweDCIS). We studied mammograms from cases with an ipsilateral breast event (IBE) and from a subcohort randomly sampled at baseline. Lesions were classified as a density without calcifications, architectural distortion, powdery, crushed stone-like or casting-type calcifications.

Results: Calcifications representing necrosis were found predominantly in younger women. Women with crushed stone or casting-type microcalcifications had higher histopathological grade and more extensive disease. The relative risk (RR) of a new IBE comparing those with casting-type calcifications to those without calcifications was 2.10 (95% confidence interval (CI) 0.92-4.80). This risk was confined to in situ recurrences; the RR of an IBE associated with casting-type calcifications on the mammogram adjusted for age and disease extent was 16.4 (95% CI 2.20-140).

Conclusion: Mammographic appearance of ductal carcinoma in situ of the breast is prognostic for the risk of an in situ IBE and may also be an indicator of responsiveness to RT in younger women.

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Figures

Figure 1
Figure 1
Flow chart of the selection of women to the subcohort and the case-series with ipsilateral breast events (IBE).
Figure 2
Figure 2
Cumulative incidence of local recurrences by mammographic pattern in all women; the three upper panels describe all (invasive plus in situ) recurrences in the radiotherapy (RT) arm and the control (Ctrl) arm by type of mammographic pattern of the primary lesion; the three middle panels describe invasive recurrences in the radiotherapy (RT) arm and the control (Ctrl) arm, the lower panels the in situ recurrences in the respective arm of the SweDCIS trial by mammographic pattern of the primary. Women with no calcifications, and those with architectural distortion, galactography findings, and with powdery calcifications are grouped together as ‘Other'.
Figure 3
Figure 3
Cumulative incidence of local recurrences by mammographic pattern in women ⩽56 years of age at diagnosis; the three upper panels describe all (invasive plus in situ) recurrences in the radiotherapy (RT) arm and the control (Ctrl) arm by type of mammographic pattern of the primary lesion; the three middle panels describe invasive recurrences in the radiotherapy (RT) arm and the control (Ctrl) arm, the lower panels the in situ recurrences in the respective arm of the SweDCIS trial by mammographic pattern of the primary. Women with no calcifications, and those with architectural distortion, galactography findings, and with powdery calcifications are grouped together as ‘Other'.
Figure 4
Figure 4
Cumulative incidence of local recurrences by mammographic pattern in women >56 years of age at diagnosis; the three upper panels describe all (invasive plus in situ) recurrences in the radiotherapy (RT) arm and the control (Ctrl) arm by type of mammographic pattern of the primary lesion; the three middle panels describe invasive recurrences in the radiotherapy (RT) arm and the control (Ctrl) arm, the lower panels the in situ recurrences in the respective arm of the SweDCIS trial by mammographic pattern of the primary. Women with no calcifications, and those with architectural distortion, galactography findings and powdery calcifications are grouped together as ‘Other'.
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References

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