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. 2016 Oct;159(3):553-63.
doi: 10.1007/s10549-016-3973-y. Epub 2016 Sep 8.

Subsequent risk of ipsilateral and contralateral invasive breast cancer after treatment for ductal carcinoma in situ: incidence and the effect of radiotherapy in a population-based cohort of 10,090 women

Lotte E Elshof  1   2   3 , Michael Schaapveld  2 , Marjanka K Schmidt  1   2 , Emiel J Rutgers  3 , Flora E van Leeuwen  2 , Jelle Wesseling  4   5
Affiliations

Subsequent risk of ipsilateral and contralateral invasive breast cancer after treatment for ductal carcinoma in situ: incidence and the effect of radiotherapy in a population-based cohort of 10,090 women

Lotte E Elshof et al. Breast Cancer Res Treat. 2016 Oct.

Erratum in

Abstract

Purpose: To assess the effect of different treatment strategies on the risk of subsequent invasive breast cancer (IBC) in women diagnosed with ductal carcinoma in situ (DCIS).

Methods: Up to 15-year cumulative incidences of ipsilateral IBC (iIBC) and contralateral IBC (cIBC) were assessed among a population-based cohort of 10,090 women treated for DCIS in the Netherlands between 1989 and 2004. Multivariable Cox regression analyses were used to evaluate associations of treatment with iIBC risk.

Results: Fifteen years after DCIS diagnosis, cumulative incidence of iIBC was 1.9 % after mastectomy, 8.8 % after BCS+RT, and 15.4 % after BCS alone. Patients treated with BCS alone had a higher iIBC risk than those treated with BCS+RT during the first 5 years after treatment. This difference was less pronounced for patients <50 years [hazard ratio (HR) 2.11, 95 % confidence interval (CI) 1.35-3.29 for women <50, and HR 4.44, 95 % CI 3.11-6.36 for women ≥50, P interaction < 0.0001]. Beyond 5 years of follow-up, iIBC risk did not differ between patients treated with BCS+RT or BCS alone for women <50. Cumulative incidence of cIBC at 15 years was 6.4 %, compared to 3.4 % in the general population.

Conclusions: We report an interaction of treatment with age and follow-up period on iIBC risk, indicating that the benefit of RT seems to be smaller among younger women, and stressing the importance of clinical studies with long follow-up. Finally, the low cIBC risk does not justify contralateral prophylactic mastectomies for many women with unilateral DCIS.

Keywords: Ductal carcinoma in situ; Invasive breast cancer; Population-based cohort study; Radiotherapy; Surgery.

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Conflict of interest statement

LE Elshof, M Schaapveld, MK Schmidt, EJ Rutgers, FE van Leeuwen, and J Wesseling declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent The study was approved by the review boards of the Netherlands Cancer Regsitry and PALGA, the nationwide histopathology and cytopathology data network and archive. The study used only unidentifiable patient information, and no informed consent was required. Reasearch involving human and animal rights This article does not contain any studies with animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Flow diagram for patient selection and median follow-up by initial treatment type. iIBC ipsilateral invasive breast cancer, cIBC contralateral invasive breast cancer
Fig. 2
Fig. 2
Treatment strategy by year of diagnosis for a women <50 years and b women ≥50 years. BCS breast-conserving surgery, RT radiotherapy
Fig. 3
Fig. 3
Cumulative incidence of iIBC by treatment strategy for a women <50 years diagnosed between 1989 and 1998 b women ≥50 years diagnosed between 1989 and 1998 c women <50 years diagnosed between 1999 and 2004 d women ≥50 years diagnosed between 1999 and 2004, with death as competing risk. BCS breast-conserving surgery, RT radiotherapy. P values based on competing risk regression, adjusted for age (continuous) [30]
Fig. 4
Fig. 4
Cumulative incidence of cIBC by treatment strategy compared with the expected cumulative incidence of IBC in the general population (dashed line) for a women <50 years, and b women ≥50 years, with death as competing risk. BCS breast-conserving surgery, RT radiotherapy. P values based on competing risk regression, adjusted for age (continuous) [30]
See this image and copyright information in PMC

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