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Comparative Study
. 2014 Nov;21(12):3766-73.
doi: 10.1245/s10434-014-3802-7. Epub 2014 May 24.

Characterization and treatment of local recurrence following breast conservation for ductal carcinoma in situ

Caprice C Greenberg  1 , Laurel A Habel, Melissa E Hughes, Larissa Nekhlyudov, Ninah Achacoso, Luana Acton, Deborah Schrag, Wei Jiang, Stephen Edge, Jane C Weeks, Rinaa S Punglia
Affiliations
Comparative Study

Characterization and treatment of local recurrence following breast conservation for ductal carcinoma in situ

Caprice C Greenberg et al. Ann Surg Oncol. 2014 Nov.

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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Conflict of interest statement

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.

Figures

FIG. 1
FIG. 1
Development of the analytic cohort from the NCCN data sources. NCCN National Comprehensive Cancer Network, BCS breast-conserving surgery, DCIS ductal carcinoma in situ
FIG. 2
FIG. 2
Development of the analytic cohorts from the CRN DCIS Study. CRN Cancer Research Network, DCIS ductal carcinoma in situ, KPNC Kaiser Permanente Northern California, HPHC Harvard Pilgrim Health Care
See this image and copyright information in PMC

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