Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Nov;208(2):237-251.
doi: 10.1007/s10549-024-07473-w. Epub 2024 Aug 24.

Outcomes from low-risk ductal carcinoma in situ: a systematic review and meta-analysis

Qian Chen  1 , Ian Campbell  2 , Mark Elwood  1 , Alana Cavadino  1 , Phyu Sin Aye  3 , Sandar Tin Tin  4   5
Affiliations
Meta-Analysis

Outcomes from low-risk ductal carcinoma in situ: a systematic review and meta-analysis

Qian Chen et al. Breast Cancer Res Treat. 2024 Nov.

Abstract

Purpose: The current standard of treatment for ductal carcinoma in situ (DCIS) is surgery with or without adjuvant radiotherapy. With a growing debate about overdiagnosis and overtreatment of low-risk DCIS, active surveillance is being explored in several ongoing trials. We conducted a systematic review and meta-analysis to evaluate the recurrence of low-risk DCIS under various treatment approaches.

Methods: PubMed, Embase, Web of Science, and Cochrane were searched for studies reporting ipsilateral breast tumour event (IBTE), contralateral breast cancer (CBC), and breast cancer-specific survival (BCSS) rates at 5 and 10 years in low-risk DCIS. The primary outcome was invasive IBTE (iIBTE) defined as invasive progression in the ipsilateral breast.

Results: Thirty three eligible studies were identified, involving 47,696 women with low-risk DCIS. The pooled 5-year and 10-year iIBTE rates were 3.3% (95% confidence interval [CI]: 1.3, 8.1) and 5.9% (95% CI: 3.8, 9.0), respectively. The iIBTE rates were significantly lower in patients who underwent surgery compared to those who did not, at 5 years (3.5% vs. 9.0%, P = 0.003) and 10 years (6.4% vs. 22.7%, P = 0.008). Similarly, the 10-year BCSS rate was higher in the surgery group (96.0% vs. 99.6%, P = 0.010). In patients treated with breast-conserving surgery, additional radiotherapy significantly reduced IBTE risk, but not total-CBC risk.

Conclusion: This review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS. However, our findings were primarily based on observational studies, and should be confirmed with the results from the ongoing trials.

Keywords: Ductal carcinoma in situ; Low-risk DCIS; Outcomes; Radiotherapy; Surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of search results according to PRISMA
Fig. 2
Fig. 2
Pooled analysis of 5-year a, 10-year b iIBTE rates and 10-year BCSS rates c in low-risk DCIS comparing no surgery and surgery
See this image and copyright information in PMC

References

    1. Tan PH, Ellis I, Allison K, Brogi E, Fox SB et al (2020) The 2019 WHO classification of tumours of the breast. Histopathology. 10.1111/his.14091 - PubMed
    1. Virnig BA, Tuttle TM, Shamliyan T, Kane RL (2010) Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 102:170–178. 10.1093/jnci/djp482 - PubMed
    1. Gangnon RE, Sprague BL, Stout NK, Alagoz O, Weedon-Fekjaer H et al (2015) The contribution of mammography screening to breast cancer incidence trends in the United States: an updated age-period-cohort model. Cancer Epidemiol Biomarkers Prev 24:905–912. 10.1158/1055-9965.EPI-14-1286 - PMC - PubMed
    1. Collins LC, Tamimi RM, Baer HJ, Connolly JL, Colditz GA, Schnitt SJ (2005) Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses’ Health Study. Cancer 103:1778–1784. 10.1002/cncr.20979 - PubMed
    1. Sanders ME, Schuyler PA, Dupont WD, Page DL (2005) The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer 103:2481–2484. 10.1002/cncr.21069 - PubMed

MeSH terms

LinkOut - more resources