Recurrence Rates Fall For In-Situ Ductal Breast Cancer

Kimberly J. Van Zee, MD, FACS Surgical oncologist Memorial Sloan-Kettering Cancer MedicalResearch.com Interview with:
Kimberly J. Van Zee, MD, FACS
Surgical oncologist
Memorial Sloan-Kettering Cancer

Medical Research: Why is this study important?

Dr. Van Zee: It is very important because the 4 large studies that randomized women with DCIS to radiation or not after they had breast-conserving surgery all began between 1985 and 1990.  Those studies are generally used to help women and clinicians estimate risk of subsequent recurrence in the same breast over time.  This study shows that recurrence rates have significantly fallen over the decades, suggesting that the recurrence rates observed in those studies are higher than what would be expected in the current era.  This is good news for women that want to have breast conservation for DCIS!

Medical Research: What are the key findings?

Dr. Van Zee:

  1. a)       Recurrence rates have fallen over the years, by about 40% between the early period (1978-1998) and the later period (1999-2010).
  2. b)      The decrease in recurrence rates is only partly explained by factors such as increased screening, wider margins, more frequent use of endocrine therapy (ie, tamoxifen).
  3. c)       The improvement in recurrence rates is mostly due to a decrease in recurrence rates for women NOT undergoing radiation (even though women having radiation continue to have a lower recurrence rate than those not having radiation)
  4. d)      This last point is important because since radiation is given only to reduce local recurrence rates and has never been shown to improve survival (survival is excellent with all treatments).  So a woman treated currently with breast conservation without radiation can expect about a  40% lower recurrence rate than in the earlier decades.

Medical Research: What are the most important things patients with DCIS should know about your study’s findings?

Dr. Van Zee: That their estimated risk of recurrence if treated today is lower than in the past, especially for women who undergo surgical excision (lumpectomy) without radiation (although women undergoing radiation continue to have lower risk of recurrence than those not undergoing radiation).

Medical Research: Why is it difficult to explain the decline in recurrence rates in the last three decades?

Dr. Van Zee: Our analysis adjusted for numerous factors that are known to affect recurrence rates, several of which did improve over the decades.  But even after adjustment for all of those factors, there remained a lower risk of recurrence in recent years.  This suggests that there are other factors which have improved, such as improvements in radiologic detection (ie, not just more widespread use of mammography, which we could adjust for, but improved quality of mammograms that allows better detection) and improvement in pathology assessment (ie, pathology assessment currently is probably much more specialized and detailed than decades ago which results in lower rates of recurrence)

Medical Research: Is more research needed to explore this subject?

Dr. Van Zee: Yes, more research could confirm in other populations this decrease in recurrence rates, and could help elucidate other factors that are responsible for the decrease.

Medical Research: What database did you use in this study?

Dr. Van Zee: A database of all women undergoing breast conserving surgery for DCIS at Memorial Sloan Kettering.  Women have been prospectively entered into the database and contacted annually to learn if they’ve had recurrences.

Medical Research: Are your findings generalizable to all US women with DCIS?

Dr. Van Zee: Probably, at least to some degree.  Others have observed declines in local recurrence in smaller series of women.  Because of their smaller series they were unable to adjust for the numerous factors for which we could adjust.  And even after our adjustment for factors that are known to affect recurrence, the rate of recurrence has fallen.

Citation:

2015 Breast Cancer Symposium abstract:

Recurrence rates for ductal carcinoma in situ: Analysis of 2,996 patients treated with breast-conserving surgery over 30 years.

Category: Local/Regional Therapy Subcategory:  Ductal Carcinoma In Situ

Oral Abstract Session A
Poster Session A: Risk Assessment, Prevention, Early Detection, Screening, and
Abstract Number:  32

Citation:  J Clin Oncol 33, 2015 (suppl 28S; abstr 32)

Author(s):

Kimberly J. Van Zee, Preeti Subhedar, Cristina Olcese, Sujata Patil, Monica Morrow; Breast Service, Dept of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Dept of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY

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Kimberly J. Van Zee, MD, FACS (2015). Recurrence Rates Fall For In-Situ Ductal Breast Cancer