title: Biology, treatment, and outcome in very young and older women with DCIS.
abstract: BACKGROUND
  This study examines a modern cohort of women with ductal carcinoma-in-situ (DCIS) in order to identify potential differences in clinical presentation, treatments, and outcome based on age.
  
  
  METHODS
  From 1996 to 2009, a total of 2037 patients with pure DCIS were treated. Clinical presentation, pathologic factors, type of surgery and adjuvant therapy, and local recurrence rates among age groups were compared and analyzed. Median follow-up was 5.2 years.
  
  
  RESULTS
  There were 132 patients (6.5 %) aged <40, 1,690 (83 %) aged 40-70, and 215 (10.5 %) aged >70. Younger patients (<40) were significantly more likely to have a family history of breast cancer, present with clinical symptoms, undergo mastectomy with immediate reconstruction, and have a contralateral prophylactic mastectomy (P < 0.05). Older patients (>70) were significantly less likely to use adjuvant radiotherapy and tamoxifen (P < 0.05). No significant differences were found in DCIS size, estrogen receptor status, necrosis, or contralateral breast cancer based on age. Among women <40, 29.3 % had evidence of multicentric disease versus 17.7 and 13.3 % in the women aged 40-70 and those >70, respectively (P = 0.004). On multivariate analysis, younger age (<40), larger-size DCIS (≥1.5 cm), and no use of radiotherapy were significant independent predictors of locoregional recurrence. The 5 year rates of local recurrence were 10.1 % in women <40 compared with 3.2 % in older women (P = 0.005).
  
  
  CONCLUSIONS
  Younger patients with DCIS more often have multicentric disease, present with clinical findings, and opt for or require mastectomy with immediate reconstruction. Conservative surgery is only appropriate for younger patients if adjuvant radiotherapy is delivered.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Alvarado
authors.forename: Sara A
authors.initials: SA
authors.lastname: Lari
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mittendorf
authors.forename: Banu K
authors.initials: BK
authors.lastname: Arun
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Wagner
authors.forename: Abigail S
authors.initials: AS
authors.lastname: Caudle
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Rosa F
authors.initials: RF
authors.lastname: Hwang
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult