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. 2024 Sep;131(5):852-859.
doi: 10.1038/s41416-024-02785-6. Epub 2024 Jul 9.

Invasive recurrence after breast conserving treatment of ductal carcinoma in situ of the breast in the Netherlands: time trends and the association with tumour grade

Rebecca L O'Leary  1 , Lucien E M Duijm  2 , Liesbeth J Boersma  3 , Maurice J C van der Sangen  4 , Linda de Munck  5 , Jelle Wesseling  6   7   8 , Robert-Jan Schipper  9 , Adri C Voogd  10   11
Affiliations

Invasive recurrence after breast conserving treatment of ductal carcinoma in situ of the breast in the Netherlands: time trends and the association with tumour grade

Rebecca L O'Leary et al. Br J Cancer. 2024 Sep.

Abstract

Background: The first aim of this study was to examine trends in the risk of ipsilateral invasive breast cancer (iIBC) after breast-conserving surgery (BCS) of ductal carcinoma in situ (DCIS). A second aim was to analyse the association between DCIS grade and the risk of iIBC following BCS.

Patients and methods: In this population-based, retrospective cohort study, the Netherlands Cancer Registry collected information on 25,719 women with DCIS diagnosed in the period 1989-2021 who underwent BCS. Of these 19,034 received adjuvant radiotherapy (RT). Kaplan-Meier analyses and Cox regression models were used.

Results: A total of 1135 patients experienced iIBC. Ten-year cumulative incidence rates of iIBC for patients diagnosed in the periods 1989-1998, 1999-2008 and 2009-2021 undergoing BCS without RT, were 12.6%, 9.0% and 5.0% (P < 0.001), respectively. For those undergoing BCS with RT these figures were 5.7%, 3.7% and 2.2%, respectively (P < 0.001). In the multivariable analyses, DCIS grade was not associated with the risk of iIBC.

Conclusion: Since 1989 the risk of iIBC has decreased substantially and has become even lower than the risk of invasive contralateral breast cancer. No significant association of DCIS grade with iIBC was found, stressing the need for more powerful prognostic factors to guide the treatment of DCIS.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. DCIS grade.
Distribution of DCIS grade according to period of diagnosis (n = 25,719).
Fig. 2
Fig. 2. Adjuvant radiotherapy.
Use of adjuvant radiotherapy after breast-conserving surgery, according to DCIS grade and period of diagnosis (n = 22,287).
Fig. 3
Fig. 3. Cumulative incidence of ipsilateral invasive breast cancer for patients with DCIS according to period of diagnosis.
a Patients undergoing BCS only. b Patients undergoing BCS with radiotherapy. Periods of diagnosis are: 1989–1999, 1999–2008 and 2009–2021.
Fig. 4
Fig. 4. Cumulative incidence of ipsilateral invasive breast cancer for patients with DCIS according to DCIS grade.
a Patients undergoing BCS only. b Patients undergoing BCS with radiotherapy.
See this image and copyright information in PMC

References

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