title: Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study.
abstract: Randomized trials have demonstrated the efficacy of radiation and tamoxifen in reducing risk of second events after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS), but the comparative effectiveness of mastectomy, BCS, and adjuvant treatments have not been established in community practice. We examined disease-free survival (DFS) among 1,676 DCIS cases diagnosed during 1995-2006 in the population-based Wisconsin In Situ Cohort study. Information on patient and tumor characteristics, treatments, and second breast cancer events were collected via a comprehensive review of data from patient interviews, the statewide cancer registry, and pathology reports. Breast cancer DFS was evaluated according to treatment while adjusting for patient and tumor characteristics. After an average of 7.1 years of follow-up, 143 second breast cancer events occurred. Overall 5-year DFS was similar among women treated with ipsilateral mastectomy (95.6 %; 95 % CI 93.5-97.0) compared to women treated with BCS and radiation (94.8 %; 95 % CI 92.8-96.1), though women receiving BCS without radiation experienced poorer overall DFS (87.0 %; 95 % CI 80.6-91.5). Women treated with tamoxifen in addition to BCS and radiation had a similar risk of a second breast event, although the hazard ratio (HR) suggested a potential benefit (0.70, 95% CI 0.41-1.19). Women treated with BCS, radiation, and tamoxifen had comparable risk of a second event as those treated with ipsilateral mastectomy (HR = 1.20; 95 % CI 0.71-2.02). In this population-based sample, the use of BCS with radiation and tamoxifen resulted in high DFS rates comparable to those achieved by ipsilateral mastectomy.
authors: Department of Surgery and Office of Health Promotion Research, University of Vermont, South Prospect St, Rm 4425, Burlington, VT 05401, USA. bsprague@uvm.edu
authors: Brian L
authors: BL
authors: Sprague
authors: Vicki
authors: V
authors: McLaughlin
authors: John M
authors: JM
authors: Hampton
authors: Polly A
authors: PA
authors: Newcomb
authors: Amy
authors: A
authors: Trentham-Dietz
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D013629:Tamoxifen / Q000627:therapeutic use; D016896:Treatment Outcome; D014922:Wisconsin / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D020847:Estrogen Receptor Modulators; D013629:Tamoxifen
references: J Natl Cancer Inst. 2011 Mar 16;103(6):478-88
references: 21398619
references: Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):703-10
references: 17544591
references: Cancer. 1999 Aug 1;86(3):429-38
references: 10430251
references: Lancet. 1999 Jun 12;353(9169):1993-2000
references: 10376613
references: J Natl Cancer Inst Monogr. 2010;2010(41):162-77
references: 20956824
references: J Natl Cancer Inst. 2006 Sep 20;98(18):1302-10
references: 16985249
references: Lancet Oncol. 2011 Jan;12(1):21-9
references: 21145284
references: JAMA. 2009 Aug 26;302(8):846-8
references: 19706857
references: Breast Cancer Res. 2009;11(6):R85
references: 19922614
references: Br J Cancer. 2006 Aug 7;95(3):393-7
references: 16804522
references: Cancer Epidemiol Biomarkers Prev. 2007 Nov;16(11):2262-8
references: 18006914
references: J Clin Oncol. 2008 Mar 10;26(8):1247-52
references: 18250350
references: Breast Cancer Res Treat. 2010 Nov;124(2):487-95
references: 20361251
references: N Engl J Med. 1993 Jun 3;328(22):1581-6
references: 8292119
references: Cancer. 1999 Feb 1;85(3):616-28
references: 10091735
references: J Natl Cancer Inst Monogr. 2010;2010(41):139-41
references: 20956818
references: J Natl Cancer Inst. 2010 Feb 3;102(3):161-9
references: 20071686
references: JAMA. 1996 Mar 27;275(12):913-8
references: 8598618
references: Breast Cancer Res Treat. 2011 Oct;129(3):929-38
references: 21537936
references: Radiother Oncol. 2011 Aug;100(2):195-9
references: 21411161
references: Semin Oncol. 2001 Aug;28(4):400-18
references: 11498833
references: Cancer. 2005 Nov 1;104(9):1840-8
references: 16136599
references: Arch Intern Med. 2000 Apr 10;160(7):953-8
references: 10761960
references: Am J Epidemiol. 1995 Dec 15;142(12):1255-64
references: 7503045
references: J Natl Cancer Inst. 2011 Jan 19;103(2):92-104
references: 21200025
references: Ann Surg Oncol. 2008 Jan;15(1):235-43
references: 17987342
references: J Clin Oncol. 2006 Jul 20;24(21):3381-7
references: 16801628
references: Cancer Epidemiol Biomarkers Prev. 1998 Aug;7(8):689-96
references: 9718221
references: J Clin Oncol. 1998 Feb;16(2):441-52
references: 9469327
references: Cancer. 1995 Mar 15;75(6):1310-9
references: 7882281
references: JAMA. 2012 Feb 1;307(5):467-75
references: 22298678
references: J Natl Cancer Inst Monogr. 2010;2010(41):218-22
references: 20956834
references: J Natl Cancer Inst. 2004 Sep 1;96(17):1311-21
references: 15339969