Large and diffuse ductal carcinoma in situ: potentially lethal subtypes of "preinvasive" disease

Int J Clin Oncol. 2021 Oct 7. doi: 10.1007/s10147-021-02036-1. Online ahead of print.ABSTRACTPURPOSE: Trials for DCIS have not explored whether outcomes for patients with large disease burden requiring mastectomy are comparable to those of patients with lumpectomy-amenable disease. We aim to identify whether patients with DCIS larger than 5 cm and diffuse-type DCIS differ in breast cancer mortality (BCM) from patients with disease less than 5 cm.METHODS: Patients diagnosed with DCIS in the SEER program were assessed to identify factors prognostic of breast-cancer-specific survival using competing risks regression.RESULTS: 44,849 patients met criteria for the cumulative incidence estimate. On competing risks cumulative incidence approximation, the 10-year estimate for BCM for each group was 1.3%, 1.3%, 2.3%, and 5.1%, respectively, and the difference among groups was significant (p = 0.017). On competing risks regression of patients with known covariates, both diffuse-type disease and disease larger than 5 cm (hazard ratio [HR] = 6.2 and 1.7, p = 0.013 and p = 0.042, respectively) were associated with increased risk of BCM. After matching, DCIS> 5 cm and diffuse disease were associated with increased BCM relative to disease
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Source Type: research

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AbstractPurposeTrials for  DCIS have not explored whether outcomes for patients with large disease burden requiring mastectomy are comparable to those of patients with lumpectomy-amenable disease. We aim to identify whether patients with DCIS larger than 5 cm and diffuse-type DCIS differ in breast cancer mortality (BCM)  from patients with disease less than 5 cm.MethodsPatients diagnosed with DCIS in the SEER program were assessed to identify factors prognostic of breast-cancer-specific survival using competing risks regression.Results44,849 patients met criteria for the cumulative incidence e...
Source: International Journal of Clinical Oncology - Category: Cancer & Oncology Source Type: research
Am Fam Physician. 2021 Aug 1;104(2):171-178.ABSTRACTBreast cancer is the leading cause of death from cancer in women worldwide, and the second most common cause of death from cancer in women in the United States. Risk assessment tools can identify the risk of breast cancer, and patients at high risk may be candidates for risk-reducing medications. The choice of medication varies with menopausal status. Breast cancer treatment depends on the stage. Stage 0 is ductal carcinoma in situ, which is noninvasive but progresses to invasive cancer in up to 40% of patients. Ductal carcinoma in situ is treated with lumpectomy and radi...
Source: American Family Physician - Category: Primary Care Authors: Source Type: research
CONCLUSIONS: Recurrence following BCS with CSMs can be stratified based on both lumpectomy and cavity shave margin positivity. Routine excision of CSMs allows identification of these patient subsets.PMID:34196595 | DOI:10.1177/00031348211030464
Source: The American Surgeon - Category: Surgery Authors: Source Type: research
CONCLUSION: Bracketing techniques using multiple radioactive seeds expands the indications for breast conservation therapy in patients who would have traditionally required mastectomy. Intraoperative margin assessment improves surgical and pathologic success. Larger defects created by multifocal resection are optimally managed in concert with oncoplastic reconstruction to minimize asymmetries and aesthetic defects.PMID:34187752 | DOI:10.1016/j.clbc.2021.05.013
Source: Clinical Genitourinary Cancer - Category: Cancer & Oncology Authors: Source Type: research
ConclusionResidual occult disease was shown to be a frequent event in this analysis of lumpectomy with circumferential shave margins. Having a positive initial lumpectomy margin was predictive of ROD in a non-corresponding margin. Surgeons should consider not being selective in their shave margins or margin of re-excision if shave margins were not obtained in their initial surgery.
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research
This study showed that increased cancer risk persisted for more than 15 years after a diagnosis of DCIS, and that more intensive therapy than lumpectomy alone — whether with mastectomy, radiation therapy, or endocrine therapy — reduced the risk of invasive breast cancer among women with DCIS. The lowest risk of invasive breast cancer was in women who chose mastectomy. The risk of invasive breast cancer was seen regardless of severity of DCIS. Women who had low- or moderate-grade DCIS, as well as high-grade DCIS, had long-term increased risk. Women who are recently diagnosed with DCIS should work with their trea...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Breast Cancer Women's Health Source Type: blogs
If you dread your annual mammogram, you’re not alone. For many women, this breast cancer screening examination can be painful, stressful, and just an overall hassle. You may wonder, are you old enough to give it up? If you’re over age 75, the answer is: maybe or maybe not. The fact is, breast cancer screening isn’t right for all older adults, but there’s no expert consensus on the right age to stop. This is mostly because scientific evidence in this area is lacking, says Dr. Kathryn Rexrode, associate professor of medicine at Harvard Medical School and chief of the Division of Women’s Health a...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Breast Cancer Healthy Aging Managing your health care Screening Women's Health Source Type: blogs
Abstract We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of ...
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research
ConclusionsA novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
AbstractTreatment for ductal carcinoma in-situ (DCIS) has historically been extrapolated from studies of invasive breast cancer. Accepted local therapy approaches range from small local excisions, with or without radiation, to bilateral mastectomies. Systemic treatment with endocrine therapy is often recommended for hormone positive patients. With improvements in imaging, pathologic review, and treatment techniques in the modern era, combined with new information regarding tumor biology, the management of DCIS is rapidly evolving. A multidisciplinary approach to treatment is now more important than ever, with a shift towar...
Source: Journal of Mammary Gland Biology and Neoplasia - Category: Cancer & Oncology Source Type: research
More News: Breast Cancer | Breast Carcinoma | Breast Lumpectomy | Cancer | Cancer & Oncology | Carcinoma | Carcinoma in Situ | DCIS (Ductal Carcinoma in Situ) | Ductal Carcinoma | Lumpectomy | Mastectomy | Study