title: Ductal carcinoma in situ of the breast in younger women: a subgroup of patients at high risk.
abstract: BACKGROUND
  After breast conservative treatment (BCT), young age is a predictive factor for recurrence in patients with Ductal Carcinoma In Situ (DCIS) of the breast. The purpose of this study was to evaluate predictive factors for recurrence and outcomes in these younger women (under 40 years) treated for pure DCIS.
  
  
  METHODS
  From 1974 to 2003, 207 cases were collected in 12 French Cancer Centers. Median age was 36.3 years and median follow-up 160 months. Seventy four (35.8%) underwent mastectomy, 67 (32.4%) lumpectomy alone and 66 (31.9%) lumpectomy plus radiotherapy.
  
  
  RESULTS
  37 recurrences occurred (17.8%): 14 (38%) were in situ and 23 (62%) invasive. After BCT, the overall rate of recurrence was 27% (33% in the lumpectomy plus radiotherapy group vs. 21% in the lumpectomy alone group). Comedocarcinoma subtype (p = 0.004), histological size more than 10 mm (p = 0.011), necrosis (p = 0.022) and positive margin status (p = 0.019) were statistically significant predictive factors for recurrence. The actuarial 15-year rates of local recurrence were 29%, 42% and 37% in the lumpectomy alone, lumpectomy and whole breast radiotherapy and lumpectomy + whole breast radiotherapy with additional boost groups respectively. After recurrence, the 10-year overall survival rate was 67.2%.
  
  
  CONCLUSIONS
  High recurrence rates (mainly invasive) after BCT in young women with DCIS are confirmed. BCT in this subgroup of patients is possible if clear and large margins are obtained, tumor size is under 11 mm and necrosis- and/or comedocarcinoma-free.
authors.affiliation: Department of Surgery, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France. tunon@bergonie.org
authors.forename: C
authors.initials: C
authors.lastname: Tunon-de-Lara
authors.forename: C
authors.initials: C
authors.lastname: Lemanski
authors.forename: C
authors.initials: C
authors.lastname: Cohen-Solal-Le-Nir
authors.forename: B
authors.initials: B
authors.lastname: de Lafontan
authors.forename: C
authors.initials: C
authors.lastname: Charra-Brunaud
authors.forename: L
authors.initials: L
authors.lastname: Gonzague-Casabianca
authors.forename: H
authors.initials: H
authors.lastname: Mignotte
authors.forename: E
authors.initials: E
authors.lastname: Fondrinier
authors.forename: S
authors.initials: S
authors.lastname: Giard
authors.forename: P
authors.initials: P
authors.lastname: Quetin
authors.forename: H
authors.initials: H
authors.lastname: Auvray
authors.forename: B
authors.initials: B
authors.lastname: Cutuli
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery*; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D010348:Patient Care Team; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012307:Risk Factors