title: Impact of concurrent proliferative high-risk lesions on the risk of ipsilateral breast carcinoma recurrence and contralateral breast carcinoma development in patients with ductal carcinoma in situ treated with breast-conserving therapy.
abstract: BACKGROUND
  The purpose of the study was to determine the risk of ipsilateral breast carcinoma recurrence (IBCR) and contralateral breast carcinoma (CBC) development in patients with a concurrent diagnosis of ductal carcinoma in situ (DCIS) with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS).
  
  
  METHODS
  Records of all 307 patients with DCIS treated with breast-conserving treatment (BCT) from 1968 to 1998 were analyzed. Initial pathology reports and all slides available were re-reviewed for evidence of ADH, ALH, or LCIS. Actuarial local recurrence rates were calculated.
  
  
  RESULTS
  Fifty-five cases of DCIS were associated with ADH, 11 with ALH or LCIS, and 14 with both ADH and ALH or LCIS. Overall, IBCR occurred in 14% and no significant difference in the IBCR rate was identified for patients with proliferative lesions compared with patients without these lesions (P = 0.38). Development of CBC in patients with concurrent DCIS and ADH was 4.4 times (95% confidence interval [CI], 1.44-13.63) that in patients with DCIS alone (P < 0.01). The 15-year cumulative rate of CBC development was 22.7% in patients with ALH or LCIS compared with 6.5% in patients without these lesions (P = 0.30) and 19% in patients with ADH compared with 4.1% in patients with DCIS alone (P < 0.01).
  
  
  CONCLUSIONS
  The risk of CBC development is higher with concurrent ADH than in patients with DCIS alone, and these patients may therefore be appropriate candidates for additional chemoprevention strategies. Concurrent ADH, ALH, or LCIS with DCIS is not a contraindication to BCT.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Adepoju
authors.forename: W Fraser
authors.initials: WF
authors.lastname: Symmans
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Banu
authors.initials: B
authors.lastname: Arun
authors.forename: Nour
authors.initials: N
authors.lastname: Sneige
authors.forename: Lajos
authors.initials: L
authors.lastname: Pusztai
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Aysegul
authors.initials: A
authors.lastname: Sahin
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Ames
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000517:prevention & control; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000517:prevention & control; D011230:Precancerous Conditions / Q000473:pathology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment