title: Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case-Control Study.
abstract: BACKGROUND
  Various patient, treatment, and pathologic factors have been associated with an increased risk of local recurrence (LR) following breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS). However, the strength and importance of individual factors has varied; whether combining factors improves prediction, particularly in community practice, is uncertain. In a large, population-based cohort of women with DCIS treated with BCT in three community-based practices, we assessed the validity of the Memorial Sloan-Kettering Cancer Center (MSKCC) DCIS nomogram, which combines clinical, pathologic, and treatment features to predict LR.
  
  
  METHODS
  We reviewed slides of patients with unilateral DCIS treated with BCT. Regression methods were used to estimate risks of LR. The MSKCC DCIS nomogram was applied to the study population to compare the nomogram-predicted and observed LR at 5 and 10 years.
  
  
  RESULTS
  The 495 patients in our study were grouped into quartiles and octiles to compare observed and nomogram-predicted LR. The 5-year absolute risk of recurrence for lowest and highest quartiles was 4.8 and 33.1 % (95 % CI 3.1-6.4 and 24.2-40.9, respectively; p < 0.0001). The overall correlation between 10-year nomogram-predicted recurrences and observed recurrences was 0.95. Compared with observed 10-year LR rates, the risk estimates provided by the nomogram showed good correlation, and reasonable discrimination with a c-statistic of 0.68.
  
  
  CONCLUSIONS
  The MSKCC DCIS nomogram provided good prediction of the 5- and 10-year LR when applied to a population of patients with DCIS treated with BCT in a community-based practice. This nomogram, therefore, is a useful treatment decision aid for patients with DCIS.
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA. lcollins@bidmc.harvard.edu.|Harvard Medical School, Boston, MA, USA. lcollins@bidmc.harvard.edu.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Collins
authors.affiliation: Kaiser Permanente, Northern CA, Oakland, CA, USA.
authors.forename: Ninah
authors.initials: N
authors.lastname: Achacoso
authors.affiliation: Kaiser Permanente, Southern CA, Pasadena, CA, USA.
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Harvard Vanguard Medical Associates, Boston, MA, USA.|Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.affiliation: Kaiser Permanente, Northern CA, Oakland, CA, USA.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.affiliation: Kaiser Permanente, Northern CA, Oakland, CA, USA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D018570:Risk Assessment