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. 2021 Mar;124(5):1009-1017.
doi: 10.1038/s41416-020-01152-5. Epub 2020 Nov 17.

Pathological features of 11,337 patients with primary ductal carcinoma in situ (DCIS) and subsequent events: results from the UK Sloane Project

Abeer M Shaaban  1 , Bridget Hilton  2 , Karen Clements  2 , Elena Provenzano  3   4 , Shan Cheung  2 , Matthew G Wallis  3   4 , Elinor Sawyer  5 , Jeremy S Thomas  6 , Andrew M Hanby  7 , Sarah E Pinder  5 , Alastair M Thompson  8 ; Sloane Project Steering Committee
Affiliations

Pathological features of 11,337 patients with primary ductal carcinoma in situ (DCIS) and subsequent events: results from the UK Sloane Project

Abeer M Shaaban et al. Br J Cancer. 2021 Mar.

Abstract

Background: The Sloane audit compares screen-detected ductal carcinoma in situ (DCIS) pathology with subsequent management and outcomes.

Methods: This was a national, prospective cohort study of DCIS diagnosed during 2003-2012.

Results: Among 11,337 patients, 7204 (64%) had high-grade DCIS. Over time, the proportion of high-grade disease increased (from 60 to 65%), low-grade DCIS decreased (from 10 to 6%) and mean size increased (from 21.4 to 24.1 mm). Mastectomy was more common for high-grade (36%) than for low-grade DCIS (15%). Few (6%) patients treated with breast-conserving surgery (BCS) had a surgical margin <1 mm. Of the 9191 women diagnosed in England (median follow-up 9.4 years), 7% developed DCIS or invasive malignancy in the ipsilateral and 5% in the contralateral breast. The commonest ipsilateral event was invasive carcinoma (n = 413), median time 62 months, followed by DCIS (n = 225), at median 37 months. Radiotherapy (RT) was most protective against recurrence for high-grade DCIS (3.2% for high-grade DCIS with RT compared to 6.9% without, compared with 2.3 and 3.0%, respectively, for low/intermediate-grade DCIS). Ipsilateral DCIS events lessened after 5 years, while the risk of ipsilateral invasive cancer remained consistent to beyond 10 years.

Conclusion: DCIS pathology informs patient management and highlights the need for prolonged follow-up of screen-detected DCIS.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Risk of development of subsequent ipsilateral DCIS (left) and invasive carcinoma (right) in women receiving breast-conserving surgery (BCS) by year.
The steady increase in risk of invasive disease continues after 10 years of follow-up.
Fig. 2
Fig. 2. The effect of radiotherapy (RT) on ipsilateral subsequent invasive carcinoma in patients treated with breast-conserving surgery (BCS).
Radiotherapy markedly reduced the risk of subsequent ipsilateral invasive carcinoma in patients with primary high-grade DCIS and, to a lesser extent, in the low/intermediate-grade category.
Fig. 3
Fig. 3. Ipsilateral invasive recurrence by receipt of radiotherapy (RT) and grade of DCIS in women who underwent breast-conserving surgery.
Without RT or endocrine therapy (ET), invasive carcinoma rates are higher in the high grade than in those with low/intermediate-grade DCIS up to 10 years.
See this image and copyright information in PMC

Comment in

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