title: Clinical-pathological features and treatment modalities associated with recurrence in DCIS and micro-invasive carcinoma: Who to treat more and who to treat less.
abstract: The primary aim in the management of DCIS is the prevention of recurrence and contralateral tumor. Risk factors for DCIS recurrence and appropriate treatments are still widely debated. Adjuvant therapies after surgical resection reduce recurrences and contralateral disease, but these treatments have significant financial costs, side effects and there is a group of low-risk patients who would not gain additional benefit. The aim of our analysis was to identify clinical-pathological features and treatment modalities associated with recurrence in DCIS and microinvasive carcinoma. In the Thomas Jefferson University Cancer Registry of Philadelphia, we identified 865 patients with DCIS or micro-invasive carcinoma treated between 2003 and 2013. Associations between recurrence and demographic factors (age at diagnosis, ethnicity), biological features (ER, PR and HER2) and treatment modalities (surgery, radiotherapy and endocrine treatment) were assessed. Our single institution register-based study showed that distribution of age at diagnosis and biological features did not significantly differ among ethnic groups. Younger women and micro-invasive carcinoma patients were more likely to undergo mastectomy, while African Americans were more likely to take endocrine therapy and undergo radiotherapy. In our sample only ER/PR negative DCIS were associated with significantly higher recurrence rate. Moreover, we reported a high rate of HER2 positive recurrences, suggesting that expression of this oncogene may represent a potential biomarker for DCIS at high risk of recurrence. To better define the molecular profile of the subgroup at worse prognosis might help to identify biomarkers predictive of recurrence or second tumors, identifying patients candidates for more appropriate treatments.
authors: Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA. Electronic address: angela.toss@unimore.it.
authors: Angela
authors: A
authors: Toss
authors: Department of Pathology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Juan
authors: J
authors: Palazzo
authors: Department of Surgery, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Adam
authors: A
authors: Berger
authors: Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Frances
authors: F
authors: Guiles
authors: Department of Biostatistics, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Jocelyn Andrel
authors: JA
authors: Sendecki
authors: Department of Radiation Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Nicole
authors: N
authors: Simone
authors: Department of Radiation Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Rani
authors: R
authors: Anne
authors: Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Tiffany
authors: T
authors: Avery
authors: Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Rebecca
authors: R
authors: Jaslow
authors: Department of Surgery, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Melissa
authors: M
authors: Lazar
authors: Department of Surgery, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Theodore
authors: T
authors: Tsangaris
authors: Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
authors: Massimo
authors: M
authors: Cristofanilli
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000737:chemistry / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D012307:Risk Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: DCIS; HER2 status; Micro-invasive carcinoma; Radiation therapy; Tamoxifen