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Comparative Study
. 2018 Aug 3;1(4):e181100.
doi: 10.1001/jamanetworkopen.2018.1100.

Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy

Vasily Giannakeas  1   2 , Victoria Sopik  1   3 , Steven A Narod  1   2   3
Affiliations
Comparative Study

Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy

Vasily Giannakeas et al. JAMA Netw Open. .

Erratum in

  • Error in Supplement.
    [No authors listed] [No authors listed] JAMA Netw Open. 2019 Aug 2;2(8):e1911052. doi: 10.1001/jamanetworkopen.2019.11052. JAMA Netw Open. 2019. PMID: 31418799 Free PMC article. No abstract available.

Abstract

Importance: Patients with ductal carcinoma in situ (DCIS) are treated with radiotherapy to reduce their risk of local invasive recurrence after breast-conserving surgery. However, the association of radiotherapy with breast cancer survival in patients with DCIS has not yet been clearly established.

Objective: To determine the extent to which radiotherapy is associated with reduced risk of breast cancer mortality in a large cohort of patients treated for DCIS, using a propensity score-based matching approach.

Design, setting, and participants: This cohort study of women who had first primary DCIS diagnosed between 1998 and 2014 used data from the Surveillance, Epidemiology, and End Results 18 registries database. Information on age and year of diagnosis, ethnicity, income, tumor size, tumor grade, estrogen receptor status, all treatments (surgery and radiation), and outcomes (invasive local recurrence and death from breast cancer) was abstracted for 140 366 women diagnosed with first primary DCIS. Three separate comparisons were performed using 1:1 matching: lumpectomy with radiation vs lumpectomy alone; lumpectomy alone vs mastectomy; and lumpectomy with radiation vs mastectomy.

Exposures: Use of radiotherapy and/or extent of surgery.

Main outcomes and measures: Crude and adjusted 15-year breast cancer-specific mortality.

Results: Of the 140 366 patients with DCIS in the cohort (109 712 [78.2%] white; mean [SD] age, 58.8 [12.3] years), 35 070 (25.0%) were treated with lumpectomy alone, 65 301 (46.5%) were treated with lumpectomy and radiotherapy, and 39 995 (28.5%) were treated with mastectomy. The actuarial 15-year breast cancer mortality rate was 2.33% for patients treated with lumpectomy alone, 1.74% for patients treated with lumpectomy and radiation, and 2.26% for patients treated with mastectomy. The adjusted hazard ratios for death were 0.77 (95% CI, 0.67-0.88) for lumpectomy and radiotherapy vs lumpectomy alone (29 465 propensity-matched pairs), 0.91 (95% CI, 0.78-1.05) for mastectomy alone vs lumpectomy alone (20 832 propensity-matched pairs), and 0.75 (95% CI, 0.65-0.87) for lumpectomy and radiotherapy vs mastectomy (29 865 propensity-matched pairs).

Conclusions and relevance: In patients with DCIS, treatment with lumpectomy and radiotherapy was associated with a significant reduction in breast cancer mortality compared with either lumpectomy alone or mastectomy alone. This suggests that the survival benefit of radiation is likely not due to local control, but rather to systemic effects.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Giannakeas is supported by the Canadian Institutes of Health Research Frederick Banting and Charles Best Doctoral Research Award.

Figures

Figure.
Figure.. Breast Cancer–Specific Mortality After Ductal Carcinoma In Situ in Propensity-Matched Patients Treated With Lumpectomy Alone vs Lumpectomy and Radiotherapy
See this image and copyright information in PMC

Comment in

References

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