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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.

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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

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