title: Radiotherapy after mastectomy for screen-detected ductal carcinoma in situ.
abstract: BACKGROUND
  A role for radiotherapy after mastectomy for ductal carcinoma in situ (DCIS) is unclear. Using a prospective audit of DCIS detected through the NHS Breast Screening Programme we sought to determine a rationale for the use of post mastectomy radiotherapy for DCIS.
  
  
  METHODS
  Over a nine year period, from 9972 patients with screen-detected DCIS and complete surgical, pathology, radiotherapy and follow up data, 2944 women underwent mastectomy for DCIS of whom 33 (1.1%) received radiotherapy.
  
  
  RESULTS
  Use of post mastectomy radiotherapy was significantly associated with a close (<1 mm) pathology margin (χ(2)(1) 95.81; p < 0.00001), DCIS size (χ(2) (3) 16.96; p < 0.001) and the presence of microinvasion (χ(2)(1) 3.92; p < 0.05). At a median follow up 61 months, no woman who received radiotherapy had an ipsilateral further event, and only 1/33 women (3.0%) had a contralateral event. Of the women known not to have had radiotherapy post mastectomy, 45/2894 (1.6%) had an ipsilateral further event and 83 (2.9%) had a contralateral event.
  
  
  CONCLUSIONS
  Recurrence following mastectomy for DCIS is rare. A close (<1 mm) margin, large tumour size and microinvasion, may merit radiotherapy to reduce ipsilateral recurrence.
authors: West Midlands Cancer Screening QA Reference Centre, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors: K
authors: K
authors: Clements
authors: Institute of Oncology, Level 4 - Bexley Wing, St James Hospital, Leeds LS9 7TF, UK. Electronic address: david.dodwell@nhs.net.
authors: D
authors: D
authors: Dodwell
authors: West Midlands Cancer Screening QA Reference Centre, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors: G
authors: G
authors: Lawrence
authors: Van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, UK.
authors: G
authors: G
authors: Ball
authors: Ward West 2, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
authors: A
authors: A
authors: Francis
authors: Research Oncology, Division of Cancer Studies, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
authors: S
authors: S
authors: Pinder
authors: Research Oncology, Division of Cancer Studies, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
authors: E
authors: E
authors: Sawyer
authors: Cambridge Breast Unit, Box 97 - NIHR Cambridge Biomedical Research Centre Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
authors: M
authors: M
authors: Wallis
authors: Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1400 Pressler Street, Houston 77030, USA.
authors: A M
authors: AM
authors: Thompson
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000379:methods
keywords: Breast cancer; DCIS; Mastectomy; Radiotherapy; Sloane project