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01.08.2017 | Breast Oncology | Ausgabe 10/2017

Annals of Surgical Oncology 10/2017

Contralateral Breast Cancer Risk in Women with Ductal Carcinoma In Situ: Is it High Enough to Justify Bilateral Mastectomy?

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 10/2017
Autoren:
MD Megan E. Miller, MD Shirin Muhsen, BS Cristina Olcese, PhD Sujata Patil, MD, FACS Monica Morrow, MS, MD, FACS Kimberly J. Van Zee
Wichtige Hinweise
This work was presented as an oral podium presentation at the American Society of Breast Surgeons 18th Annual Meeting, Las Vegas, NV, USA, on 28 April 2017, and received the George Peters Award for the Best Presentation by a Breast Fellow.

Abstract

Background

Women with ductal carcinoma in situ (DCIS) are increasingly choosing bilateral mastectomy. We sought to quantify rates of contralateral breast cancer (CBC) and ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) for DCIS, and to compare risk factors for CBC and IBTR.

Methods

From 1978 to 2011, DCIS patients undergoing BCS with a contralateral breast at risk were identified from a prospectively maintained database. The association of clinicopathologic and treatment factors with CBC and IBTR were evaluated using Kaplan–Meier analysis, multivariable Cox regression, and competing risk regression (CRR).

Results

Of 2759 patients identified, 151 developed CBC and 344 developed IBTR. Five- and 10-year Kaplan–Meier CBC rates were 3.2 and 6.4%. Overall, 10-year IBTR rates were 2.5-fold higher than CBC rates, and, without radiation, 4-fold higher. On CRR, 5- and 10-year rates were 2.9 and 5.8% for CBC, and 7.8 and 14.5% for IBTR. CBC risk and invasive CBC risk were not significantly associated with age, family history, presentation, nuclear grade, year of surgery, or radiation. By multivariable Cox regression, endocrine therapy was associated with lower CBC risk (hazard ratio 0.57, p = 0.03). Ten-year risk of subsequent CBC in the subset of patients who developed IBTR was similar to the cohort as a whole (8.1 vs. 6.4%).

Conclusions

CBC rates were low across all groups, including those who experienced IBTR. CBC was not associated with factors that increase IBTR risk. While factors associated with IBTR risk are important in decision making regarding management of the index DCIS, they are not an indication for contralateral prophylactic mastectomy.

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