title: Ductal intraepithelial neoplasia: postsurgical outcome for 1,267 women cared for in one single institution over 10 years.
abstract: BACKGROUND
  Diagnosis of breast ductal intraepithelial neoplasia (DIN) has increased over the last decades, but proper postsurgical treatment remains controversial. We analyzed risk factors and treatment outcome in a large series of women treated at one institution.
  
  
  METHODS
  Women undergoing surgery for DIN at the European Institute of Oncology between 1996 and 2005, with follow-up until December 2006, were included.
  
  
  RESULTS
  We evaluated the postsurgical treatment outcome of 974 and 293 patients who underwent breast-conserving surgery (BCS) or mastectomy, respectively. The 5-year cumulative incidence of breast cancer (BC) events was 11.8%, with a significant trend according to age (from 43% in women <36 years to 8% in women >65 years). Among the 727 BCS patients with DIN2-DIN3 histology, 414 (57%) received radiotherapy (RT), and they were both younger and with worse prognostic factors than the 313 patients who did not receive it. In these groups, the adjusted hazard ratio (HR) for RT versus non-RT was 0.40 (95% confidence interval [CI], 0.26-0.63). Among the 691 BCS patients with estrogen receptor (ER)(+) disease, 329 (48%) received low-dose tamoxifen (either 5 mg/day or 20 mg once a week) and they were younger than the 362 who did not receive it. In these groups, the adjusted HR for tamoxifen versus no tamoxifen was 0.68 (95% CI, 0.43-1.07), and the HR was 0.55 (95% CI, 0.32-0.97) after excluding human epidermal growth factor receptor (HER)2/neu-overexpressing DIN.
  
  
  CONCLUSIONS
  BC events were more frequent in young patients. RT was associated with a lower incidence of BC events. Low-dose tamoxifen was associated with a lower incidence of BC events in patients with ER(+) disease when HER-2 was not overexpressed. Further prospective studies should confirm our observations.
authors.affiliation: Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy.
authors.forename: Aliana
authors.initials: A
authors.lastname: Guerrieri-Gonzaga
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.forename: Fabio
authors.initials: F
authors.lastname: Bassi
authors.forename: Mattia
authors.initials: M
authors.lastname: Intra
authors.forename: Davide
authors.initials: D
authors.lastname: Serrano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Renne
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Aaron
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: Marco
authors.initials: M
authors.lastname: Colleoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ivaldi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.forename: Matteo
authors.initials: M
authors.lastname: Lazzeroni
authors.forename: Andrea
authors.initials: A
authors.lastname: Decensi
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
authors.forename: Bernardo
authors.initials: B
authors.lastname: Bonanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult