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Multicenter Study
. 2018 May;267(5):952-958.
doi: 10.1097/SLA.0000000000002239.

Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ

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

Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ

Lotte E Elshof et al. Ann Surg. 2018 May.

Abstract

Objective: To assess cause-specific mortality in women treated for ductal carcinoma in situ (DCIS).

Background: From screening and treatment perspective, it is relevant to weigh the low breast cancer mortality after DCIS against mortality from other causes and expected mortality in the general population.

Methods: We conducted a population-based cohort study comprising 9799 Dutch women treated for primary DCIS between 1989 and 2004 and estimated standardized mortality ratios (SMRs).

Results: After a median follow up of 9.8 years, 1429 patients had died of whom 284 caused by breast cancer (2.9% of total cohort). DCIS patients <50 years experienced higher mortality compared with women in the general population (SMR 1.7; 95% confidence interval, CI: 1.4-2.0), whereas patients >50 had significantly lower mortality (SMR 0.9; 95% CI: 0.8-0.9). Overall, the risk of dying from general diseases and cancer other than breast cancer was lower than in the general population, whereas breast cancer mortality was increased. The SMR for breast cancer decreased from 7.5 (95% CI: 5.9-9.3) to 2.8 (95% CI: 2.4-3.2) for women aged <50 and >50 years, respectively. The cumulative breast cancer mortality 10 years after DCIS was 2.3% for women <50 years and 1.4% for women >50 years treated for DCIS between 1999 and 2004.

Conclusions: DCIS patients >50 years had lower risk of dying from all causes combined compared with the general female population, which may reflect differences in health behavior. Women with DCIS had higher risk of dying from breast cancer than the general population, but absolute 10-year risks were low.

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Conflict of interest statement

BCS indicates breast conserving surgery; CI, confidence interval; DCIS, ductal carcinoma in situ; NA, not applicable; RT, radiotherapy; SHR, subdistribution hazard ratio (with death due to other causes as a competing event).

Model 1: adjusted for age at DCIS diagnosis, period of DCIS diagnosis and DCIS grade.

Model 2: adjusted for age at DCIS diagnosis, period of DCIS diagnosis, DCIS grade and subsequent invasive breast cancer; with subsequent ipsilateral and contralateral invasive breast cancer as time-dependent variables.

Figures

FIGURE 1
FIGURE 1
Observed and expected number of deaths from various disease categories in population-based cohort of 9799 DCIS patients (P < 0.05).
FIGURE 2
FIGURE 2
Fifteen-year absolute risks of breast cancer mortality by treatment (P < 0.05). With death caused by other causes as a competing event.
See this image and copyright information in PMC

Comment in

References

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