Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review and meta-analysis

K. E. Stuart, N. Houssami, R. Taylor, J. Boyages

Research output: Contribution to journalMeeting abstractResearch

Abstract

Purpose/Objective(s): A systematic review was undertaken to define 10 year local recurrence and breast cancer case fatality for women with ductal carcinoma in situ (DCIS) under different treatment modalities. Materials/Methods: A meta-analysis of observational studies was conducted. Studies eligible for inclusion reported data where all subjects (or subgroups): (1) were diagnosed with pure DCIS, (2) had a minimum median/mean follow-up of 10 years, (3) had details provided on type of surgery (mastectomy, breast conservation or biopsy only) and radiation therapy (RT) received, and (4) had ipsilateral local recurrence (ILR) by local treatment reported. All published studies were considered; no language, publication date or study-type restrictions were imposed. Evaluation of the heterogeneity of all studies, individually and by treatment type, and the calculation of the pooled proportions (overall and by treatment type) was undertaken by variance weighting according to the method described by Berry for small numbers. Fixed or random effects models were used as appropriate with confidence intervals (95% CIs) of pooled proportions derived from the normal approximation of the binomial. Results: Eighteen observational studies were eligible for inclusion in the meta-analysis, providing a total of 3069 women diagnosed with DCIS. At 10 years follow-up, the proportion of any ILR for women treated by mastectomy (Mx) was 3.3% (95% CI, 0.9 – 5.7), for breast conserving surgery (BCS) with RTwas 14.7% (95% CI, 12.8 – 16.6), for BCS alone was 24.2% (95% CI, 16.9 – 31.4), and for biopsy only (Bx) was 35.1% (95% CI, 13.2 – 57.0). Outcomes for the Bx group were also reported at 15 years and showed an ILR of 45.4% (95% CI, 17.5 – 73.4). Breast cancer case fatality at 10 years was similar in the Mx (1.89%, 95% CI, 0.06 – 3.72), BCS+RT (3.33%, 95% CI, 2.34 – 4.32) and BCS alone (2.5%, 95% CI, 1.59 – 3.42) groups, but was higher at 7.03% (95% CI, 2.06 – 11.46) in the Bx only patients (although 95% CIs overlapped). By 15 years, breast cancer case fatality rate in the Bx only women was 11.36% (95% CI, 5.95 – 16.78) and was particularly high (36.59%, 95% CI, 21.84 – 51.33) for those with an invasive local recurrence. Conclusions: More extensive local intervention was associated with greater local control in DCIS with 10 year follow-up. Breast cancer case fatality was similar for the Mx, BCS+RT and BCS groups. The highest proportion of ILR and breast cancer case fatality was in the Bx group at 10 years, which further increased by 15 years.

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Carcinoma, Intraductal, Noninfiltrating
Segmental Mastectomy
Meta-Analysis
Breast
Recurrence
Breast Neoplasms
Radiotherapy
Mastectomy
Observational Studies
Biopsy
Therapeutics
Publications
Fruit
Language
Confidence Intervals
Mortality

Cite this

@article{401589ae07544942ba0c4f4e931fabd1,
title = "Long-term outcomes of ductal carcinoma in situ of the breast: a systematic review and meta-analysis",
abstract = "Purpose/Objective(s): A systematic review was undertaken to define 10 year local recurrence and breast cancer case fatality for women with ductal carcinoma in situ (DCIS) under different treatment modalities. Materials/Methods: A meta-analysis of observational studies was conducted. Studies eligible for inclusion reported data where all subjects (or subgroups): (1) were diagnosed with pure DCIS, (2) had a minimum median/mean follow-up of 10 years, (3) had details provided on type of surgery (mastectomy, breast conservation or biopsy only) and radiation therapy (RT) received, and (4) had ipsilateral local recurrence (ILR) by local treatment reported. All published studies were considered; no language, publication date or study-type restrictions were imposed. Evaluation of the heterogeneity of all studies, individually and by treatment type, and the calculation of the pooled proportions (overall and by treatment type) was undertaken by variance weighting according to the method described by Berry for small numbers. Fixed or random effects models were used as appropriate with confidence intervals (95{\%} CIs) of pooled proportions derived from the normal approximation of the binomial. Results: Eighteen observational studies were eligible for inclusion in the meta-analysis, providing a total of 3069 women diagnosed with DCIS. At 10 years follow-up, the proportion of any ILR for women treated by mastectomy (Mx) was 3.3{\%} (95{\%} CI, 0.9 – 5.7), for breast conserving surgery (BCS) with RTwas 14.7{\%} (95{\%} CI, 12.8 – 16.6), for BCS alone was 24.2{\%} (95{\%} CI, 16.9 – 31.4), and for biopsy only (Bx) was 35.1{\%} (95{\%} CI, 13.2 – 57.0). Outcomes for the Bx group were also reported at 15 years and showed an ILR of 45.4{\%} (95{\%} CI, 17.5 – 73.4). Breast cancer case fatality at 10 years was similar in the Mx (1.89{\%}, 95{\%} CI, 0.06 – 3.72), BCS+RT (3.33{\%}, 95{\%} CI, 2.34 – 4.32) and BCS alone (2.5{\%}, 95{\%} CI, 1.59 – 3.42) groups, but was higher at 7.03{\%} (95{\%} CI, 2.06 – 11.46) in the Bx only patients (although 95{\%} CIs overlapped). By 15 years, breast cancer case fatality rate in the Bx only women was 11.36{\%} (95{\%} CI, 5.95 – 16.78) and was particularly high (36.59{\%}, 95{\%} CI, 21.84 – 51.33) for those with an invasive local recurrence. Conclusions: More extensive local intervention was associated with greater local control in DCIS with 10 year follow-up. Breast cancer case fatality was similar for the Mx, BCS+RT and BCS groups. The highest proportion of ILR and breast cancer case fatality was in the Bx group at 10 years, which further increased by 15 years.",
author = "Stuart, {K. E.} and N. Houssami and R. Taylor and J. Boyages",
year = "2011",
doi = "10.1016/j.ijrobp.2011.06.066",
language = "English",
pages = "S32--S32",
journal = "International journal of radiation oncology, biology, physics : proceedings of the American Society for Radiation Oncology 53rd annual meeting",
issn = "0360-3016",
publisher = "Elsevier",

}

TY - JOUR

T1 - Long-term outcomes of ductal carcinoma in situ of the breast

T2 - International journal of radiation oncology, biology, physics : proceedings of the American Society for Radiation Oncology 53rd annual meeting

AU - Stuart, K. E.

AU - Houssami, N.

AU - Taylor, R.

AU - Boyages, J.

PY - 2011

Y1 - 2011

N2 - Purpose/Objective(s): A systematic review was undertaken to define 10 year local recurrence and breast cancer case fatality for women with ductal carcinoma in situ (DCIS) under different treatment modalities. Materials/Methods: A meta-analysis of observational studies was conducted. Studies eligible for inclusion reported data where all subjects (or subgroups): (1) were diagnosed with pure DCIS, (2) had a minimum median/mean follow-up of 10 years, (3) had details provided on type of surgery (mastectomy, breast conservation or biopsy only) and radiation therapy (RT) received, and (4) had ipsilateral local recurrence (ILR) by local treatment reported. All published studies were considered; no language, publication date or study-type restrictions were imposed. Evaluation of the heterogeneity of all studies, individually and by treatment type, and the calculation of the pooled proportions (overall and by treatment type) was undertaken by variance weighting according to the method described by Berry for small numbers. Fixed or random effects models were used as appropriate with confidence intervals (95% CIs) of pooled proportions derived from the normal approximation of the binomial. Results: Eighteen observational studies were eligible for inclusion in the meta-analysis, providing a total of 3069 women diagnosed with DCIS. At 10 years follow-up, the proportion of any ILR for women treated by mastectomy (Mx) was 3.3% (95% CI, 0.9 – 5.7), for breast conserving surgery (BCS) with RTwas 14.7% (95% CI, 12.8 – 16.6), for BCS alone was 24.2% (95% CI, 16.9 – 31.4), and for biopsy only (Bx) was 35.1% (95% CI, 13.2 – 57.0). Outcomes for the Bx group were also reported at 15 years and showed an ILR of 45.4% (95% CI, 17.5 – 73.4). Breast cancer case fatality at 10 years was similar in the Mx (1.89%, 95% CI, 0.06 – 3.72), BCS+RT (3.33%, 95% CI, 2.34 – 4.32) and BCS alone (2.5%, 95% CI, 1.59 – 3.42) groups, but was higher at 7.03% (95% CI, 2.06 – 11.46) in the Bx only patients (although 95% CIs overlapped). By 15 years, breast cancer case fatality rate in the Bx only women was 11.36% (95% CI, 5.95 – 16.78) and was particularly high (36.59%, 95% CI, 21.84 – 51.33) for those with an invasive local recurrence. Conclusions: More extensive local intervention was associated with greater local control in DCIS with 10 year follow-up. Breast cancer case fatality was similar for the Mx, BCS+RT and BCS groups. The highest proportion of ILR and breast cancer case fatality was in the Bx group at 10 years, which further increased by 15 years.

AB - Purpose/Objective(s): A systematic review was undertaken to define 10 year local recurrence and breast cancer case fatality for women with ductal carcinoma in situ (DCIS) under different treatment modalities. Materials/Methods: A meta-analysis of observational studies was conducted. Studies eligible for inclusion reported data where all subjects (or subgroups): (1) were diagnosed with pure DCIS, (2) had a minimum median/mean follow-up of 10 years, (3) had details provided on type of surgery (mastectomy, breast conservation or biopsy only) and radiation therapy (RT) received, and (4) had ipsilateral local recurrence (ILR) by local treatment reported. All published studies were considered; no language, publication date or study-type restrictions were imposed. Evaluation of the heterogeneity of all studies, individually and by treatment type, and the calculation of the pooled proportions (overall and by treatment type) was undertaken by variance weighting according to the method described by Berry for small numbers. Fixed or random effects models were used as appropriate with confidence intervals (95% CIs) of pooled proportions derived from the normal approximation of the binomial. Results: Eighteen observational studies were eligible for inclusion in the meta-analysis, providing a total of 3069 women diagnosed with DCIS. At 10 years follow-up, the proportion of any ILR for women treated by mastectomy (Mx) was 3.3% (95% CI, 0.9 – 5.7), for breast conserving surgery (BCS) with RTwas 14.7% (95% CI, 12.8 – 16.6), for BCS alone was 24.2% (95% CI, 16.9 – 31.4), and for biopsy only (Bx) was 35.1% (95% CI, 13.2 – 57.0). Outcomes for the Bx group were also reported at 15 years and showed an ILR of 45.4% (95% CI, 17.5 – 73.4). Breast cancer case fatality at 10 years was similar in the Mx (1.89%, 95% CI, 0.06 – 3.72), BCS+RT (3.33%, 95% CI, 2.34 – 4.32) and BCS alone (2.5%, 95% CI, 1.59 – 3.42) groups, but was higher at 7.03% (95% CI, 2.06 – 11.46) in the Bx only patients (although 95% CIs overlapped). By 15 years, breast cancer case fatality rate in the Bx only women was 11.36% (95% CI, 5.95 – 16.78) and was particularly high (36.59%, 95% CI, 21.84 – 51.33) for those with an invasive local recurrence. Conclusions: More extensive local intervention was associated with greater local control in DCIS with 10 year follow-up. Breast cancer case fatality was similar for the Mx, BCS+RT and BCS groups. The highest proportion of ILR and breast cancer case fatality was in the Bx group at 10 years, which further increased by 15 years.

U2 - 10.1016/j.ijrobp.2011.06.066

DO - 10.1016/j.ijrobp.2011.06.066

M3 - Meeting abstract

SP - S32-S32

JO - International journal of radiation oncology, biology, physics : proceedings of the American Society for Radiation Oncology 53rd annual meeting

JF - International journal of radiation oncology, biology, physics : proceedings of the American Society for Radiation Oncology 53rd annual meeting

SN - 0360-3016

ER -