title: Risk factors for non-invasive and invasive local recurrence in patients with ductal carcinoma in situ.
abstract: We aimed to identify clinicopathologic factors associated with local recurrence (LR) in a large population of DCIS patients treated with breast-conserving therapy between 1990-2001 in three health plans. Regression methods were used to estimate relative risks (RR) of LR. Among 2,995 patients, 325 had a LR [10.9 %; median follow-up 4.8 years (range 0.5-15.7)]. After adjusting for health plan and treatment, risk of LR was increased among women <45 years (RR = 2.1, 95 % CI 1.5-2.8), African-Americans (RR = 1.6; 95 % CI 1.1-2.1) and those with DCIS detected because of signs/symptoms (RR = 1.6; 95 % CI 1.2-2.0). After also adjusting for age and diagnosis year, pathologic features associated with increased LR were larger lesion size (RR = 2.9 for ≥20 low power fields of DCIS; 95 % CI 1.6-5.6) and involved (RR = 2.9; 95 % CI 1.6-5.2), or close margins (RR = 2.4; 95 % CI 1.6-3.8). Presentation with symptoms/signs was associated with increased risk of invasive recurrence; while African-American race, larger tumor size, and involved/close tumor margins were more strongly associated with increased risk of DCIS recurrence. Our findings suggest some risk factors differ for non-invasive and invasive LRs and that most factors are only moderately associated with increased LR risk. Future research efforts should focus on non-clinicopathologic factors to identify more powerful risk factors for LR.
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. lcollins@bidmc.harvard.edu
authors.forename: Laura C
authors.initials: LC
authors.lastname: Collins
authors.forename: Ninah
authors.initials: N
authors.lastname: Achacoso
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology* / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012307:Risk Factors; D047368:Tumor Burden