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MEDIUM‐TERM OUTCOME OF SCREEN‐DETECTED DCIS TREATED WITH WIDE EXCISION ALONE
Author(s) -
Fong J. Y.,
Kurniawan E. D.,
Windle I.,
Rose A. K.,
Mann G. B.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04913_7.x
Subject(s) - medicine , breast cancer , ductal carcinoma , mastectomy , multivariate analysis , pathological , univariate analysis , cancer , radiation therapy , oncology , surgery
Purpose: The optimal treatment for ductal carcinoma in situ (DCIS) remains controversial. Randomised trials have shown a 50% reduction in local recurrence (LR) with the addition of radiotherapy (RT) to Wide excision (WE) with no difference in overall survival. We used our database to assess the outcome of patients with screen‐detected DCIS treated primarily with WE only. Methodology: All patients with DCIS detected through NorthWestern BreastScreen in Melbourne, Australia from 1988–2005 were identified. Demographic, pathological and outcome data were collected from BreastScreen databases, Medical Record review and the National Death Registry. Results: 490 patients were diagnosed with DCIS without invasive cancer. 3 opted out of the study. 46 were treated with mastectomy, and 45 were lost to follow‐up, leaving 396 patients for analysis. 5‐year breast cancer specific‐survival was 99.2%, and 5 year overall survival was 96.3%. There were 78 local recurrences, with a 5‐year LR rate of 15%. Factors potentially associated with LR including grade, size, margin status and age were analysed. No significant associations on Univariate or Multivariate analysis were found (p = 0.32–0.83). No sizeable subgroup with a very low risk of LR could be identified. Conclusion: Our study confirms that treatment of screen‐detected DCIS with WE alone is associated with excellent breast cancer specific survival and a moderate rate of LR. We were unable to identify associations with low recurrence rate, nor subgroups with minimal recurrence risk. Decisions regarding RT must balance inconvenience and side effects of RT with higher LR rate.