title: Breast conservation therapy for ductal carcinoma in situ (DCIS): does presentation of disease affect long-term outcomes?
abstract: BACKGROUND
  For DCIS patients eligible for breast conservation treatment (BCT), it remains unclear whether presenting with physical signs/symptoms (Phys) confers a worse long-term prognosis compared to mammographically detected DCIS (Mam).
  
  
  METHODS
  We collected data on 669 DCIS patients treated with BCT from 1974 to 2007 of whom 80 were identified as category "Phys" and 589 were in category "Mam."
  
  
  RESULTS
  Treatment parameters (i.e., the RT dose delivered, boost, rates of stereotactic biopsy, re-excision, node dissection) did not differ significantly between the two cohorts (p = NS). At a 60-month median follow-up, significant associations included younger age at presentation (p < 0.001), non-white race (p = 0.041), larger tumor size (p = 0.002), more 1°/2° papillary histology (1°, p = 0.001; 2°, p = 0.005) for the Phys cohort. As expected, mammograms were more likely to show mass/nodules/asymmetrical densities and less likely to show microcalcifications for the Phys versus Mam group (p < 0.0001). There were no differences in family history, multifocality, grade, necrosis, or residual disease at re-excision, nodal involvement, status of margins, or ER/PR/HER-2 between the cohorts. The local relapse-free survival was similar at 5 years (100 vs. 96.9 %, p = 0.116) and 10 years (96.2 vs. 96.2 %, p = 0.906), with no significant overall survival difference at 10 years (97.5 vs. 95.9 %, p = 0.364) between the Phys and Mam patients, respectively. On multivariate analysis, presentation was not an independent predictor of local relapse-free survival or overall survival when accounting for age, race, tumor size, mammogram appearance, and adjuvant hormone treatment.
  
  
  CONCLUSIONS
  Our findings suggest that although some clinicopathological differences exist between DCIS patients presenting with physical signs/symptoms compared with those presenting with mammographically detected disease, long-term outcomes are similar for patients appropriately selected for BCT.
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208040, New Haven, CT, 06520-8040, USA.
authors.forename: Harrison X
authors.initials: HX
authors.lastname: Bai
authors.forename: Sabin B
authors.initials: SB
authors.lastname: Motwani
authors.forename: Susan A
authors.initials: SA
authors.lastname: Higgins
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Wilson
authors.forename: Donald R
authors.initials: DR
authors.lastname: Lannin
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Evans
authors.forename: Meena S
authors.initials: MS
authors.lastname: Moran
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome