Declining Recurrence among Ductal Carcinoma In situ Patients Treated with Breast-Conserving Surgery in the Community Setting

DSpace/Manakin Repository

Declining Recurrence among Ductal Carcinoma In situ Patients Treated with Breast-Conserving Surgery in the Community Setting

Show simple item record

dc.contributor.author Habel, Laurel A
dc.contributor.author Achacoso, Ninah S
dc.contributor.author Haque, Reina
dc.contributor.author Geiger, Ann M
dc.contributor.author Puligandla, Balaram
dc.contributor.author Acton, Luana
dc.contributor.author Quesenberry, Charles P
dc.contributor.author Nekhlyudov, Larissa
dc.contributor.author Fletcher, Suzanne W.
dc.contributor.author Schnitt, Stuart Jay
dc.contributor.author Collins, Laura Christine
dc.date.accessioned 2011-01-14T21:51:50Z
dc.date.issued 2009
dc.identifier.citation Habel, Laurel A., Ninah S. Achacoso, Reina Haque, Larissa Nekhlyudov, Suzanne W. Fletcher, Stuart J. Schnitt, Laura C. Collins, et al. 2009. Declining recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting. Breast Cancer Research 11(6): R85. en_US
dc.identifier.issn 1465-5411 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4662036
dc.description.abstract Introduction: Randomized trials indicate that adjuvant radiotherapy plus tamoxifen decrease the five-year risk of recurrence among ductal carcinoma in situ patients treated with breast-conserving surgery from about 20% to 8%. The aims of this study were to examine the use and impact of these therapies on risk of recurrence among ductal carcinoma in situ patients diagnosed and treated in the community setting. Methods: We identified 2,995 patients diagnosed with ductal carcinoma in situ between 1990 and 2001 and treated with breast-conserving surgery at three large health plans. Medical charts were reviewed to confirm diagnosis and treatment and to obtain information on subsequent breast cancers. On a subset of patients, slides from the index ductal carcinoma in situ were reviewed for histopathologic features. Cumulative incidence curves were generated and Cox regression was used to examine changes in five-year risk of recurrence across diagnosis years, with and without adjusting for trends in use of adjuvant therapies. Results: Use of radiotherapy increased from 25.8% in 1990-1991 to 61.3% in 2000-2001; tamoxifen increased from 2.3% to 34.4%. A total of 245 patients had a local recurrence within five years of their index ductal carcinoma in situ. The five-year risk of any local recurrence decreased from 14.3% (95% confidence interval 9.8 to 18.7) for patients diagnosed in 1990-1991 to 7.7% (95% confidence interval 5.5 to 9.9) for patients diagnosed in 1998-1999; invasive recurrence decreased from 7.0% (95% confidence interval 3.8 to 10.3) to 3.1% (95% confidence interval 1.7 to 4.6). In Cox models, the association between diagnosis year and risk of recurrence was modestly attenuated after accounting for use of adjuvant therapy. Between 1990-1991 and 2000-2001, the proportion of patients with tumors with high nuclear grade decreased from 46% to 32% (P = 0.03) and those with involved surgical margins dropped from 15% to 0% (P = 0.03). Conclusions: The marked increase in the 1990s in the use of adjuvant therapy for ductal carcinoma in situ patients treated with breast-conserving surgery in the community setting only partially explains the 50% decline in risk of recurrence. Changes in pathology factors have likely also contributed to this decline. en_US
dc.language.iso en_US en_US
dc.publisher BioMed Central en_US
dc.relation.isversionof doi:10.1186/bcr2453 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815548/pdf/ en_US
dash.license LAA
dc.title Declining Recurrence among Ductal Carcinoma In situ Patients Treated with Breast-Conserving Surgery in the Community Setting en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal Breast Cancer Research en_US
dash.depositing.author Nekhlyudov, Larissa
dc.date.available 2011-01-14T21:51:50Z
dash.affiliation.other HMS^Population Medicine en_US
dash.affiliation.other HMS^Emeritus en_US
dash.affiliation.other HMS^Pathology en_US

Files in this item

Files Size Format View
2815548.pdf 238.8Kb PDF View/Open

This item appears in the following Collection(s)

Show simple item record

 
 

Search DASH


Advanced Search
 
 

Submitters