Abstract
Background: The optimal treatment of ductal carcinoma in situ (DCIS) is one of the most controversial issues in the management of breast cancer. Identification of factors that affect the risk of local recurrence is very important as the incidence of DCIS increases and the use of breast conservation becomes more widespread. Because the extent of resection may affect the relapse rate, we hypothesized that larger volumes of resection (VR) may account for the lower local recurrence rates we have previously found in elderly patients.
Methods: Between 1978 and 1990, 173 cases of histologically confirmed DCIS were treated at MSKCC with breast conservation therapy. Of these, complete VR data were available for 126 cases. The VRs thus obtained were divided into two groups, <60 cm3 and ⩾60 cm3, and were evaluated for correlating factors. The patients were divided into three groups by age at diagnosis: younger than 40 years, 40 to 69 years, and 70 years or older.
Results: The eldest group had a significantly greater proportion of large VRs (30%) as compared to the middle group (11%) and the youngest group (9%) (P=.03, x2). Although not statistically significant, the large VR group had a lower 6-year actuarial local recurrence rate (5.6%) than did the small VR group (21.3%) (P=.16, log-rank test). This trend was observed even though adjuvant radiotherapy was used less often in patients who had large VRs.
Conclusion: Breast conservation surgery for DCIS in elderly patients is more likely to employ a large VR. This may explain, at least in part, the observation that elderly patients have a lower local recurrence rate.
Similar content being viewed by others
References
Swallow CJ, Van Zee KJ, Sacchini V, Borgen PI. Ductal carcinoma in situ of the breast: progress and controversy.Curr Probl Surg 1996;33:553–608.
Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast.N Engl J Med 1981;305:6–11.
Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1989;320:822–8.
Lichter AS, Lippmann ME, Danforth DNJ, et al. Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute.J Clin Oncol 1996;10:976–83.
Schmidt-Ullrich RK, Wazer DE, DiPetrillo T, et al. Breast conservation therapy for early stage breast carcinoma with outstanding 10-year locoregional control rates: a case for aggressive therapy to the tumor bearing quadrant.Int J Radiat Oncol Biol Phys 1993;27:545–52.
Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17.J Clin Oncol 1998;16:441–52.
Faverly DRG, Burgers L, Bult P, Holland R. Three dimensional imaging of mammary ductal carcinoma in situ: clinical implications.Semin Diagn Pathol 1994;11:193–8.
Kurtz JM, Spitalier J, Amalric R, Brandone H, Ayme Y, Bressac C, Hans D. Mammary recurrences in women younger than forty.Int J Radiat Oncol Biol Phys 1988;15:271–6.
Fowble BL, Schultz DJ, Overmoyer B, et al. The influence of young age on outcome in early stage breast cancer.Int J Radiat Oncol Biol Phys 1994;30:23–33.
Recht A, Connolly JL, Schnitt SJ, Silver B, Rose MA, Love S, Harris JR. The effect of young age on tumor recurrence in the treated breast after conservative surgery and radiotherapy.Int J Radiat Oncol Biol Phys 1988;14:3–10.
Solin LJ, Fowble BL, Schultz DJ, Goodman RL. Age as a prognostic factor for patients treated with definitive irradiation for early stage breast cancer.Int J Radiat Oncol Biol Phys 1989;16:373–81.
Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG. Factors associated with surgical and radiation therapy for early stage breast cancer in older women.J Natl Cancer Inst 1996;88:716–26.
Kurtz JM, Jacquemier J, Amalric R, et al. Why are local recurrences after breast-conserving therapy more frequent in younger patients?J Clin Oncol 1990;8:591–8.
Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer.J Clin Oncol 1994;12:888–94.
Van Zee KJ, Liberman L, Samli B, et al. Long-term follow-up of 157 women with DCIS treated by breast-conserving surgery: effect of age and radiation. Presented at the 49th Cancer Symposium of the Society of Surgical Oncology, Atlanta, GA, March 21–24, 1996.
Hodgman CD, ed.Handbook of Chemistry and Physics. 31st ed. Cleveland, OH: CRC, 1948:348.
Hiramatsu H, Bornstein BA, Recht A, et al. Local recurrence after conservative surgery and radiation therapy for ductal carcinoma in situ: possible importance of family history.Cancer J Sci Am 1995;1:55–61.
Sunshine JA, Moseley HS, Fletcher WS, Krippaehne WW. Breast carcinoma in situ: a retrospective review of 112 cases with a minimum 10 year follow-up.Am J Surg 1985;150:44–51.
Price P, Sinnett HD, Gusterson B, Walsh G, A'Hern RP, McKinna JA. Duct carcinoma in situ: predictors of local recurrence and progression in patients treated by surgery alone.Br J Cancer 1990;61:869–72.
Ringberg A, Andersson I, Aspegren K, Linell F. Breast carcinoma in situ in 167 women—incidence, mode of presentation, therapy and follow-up.Eur J Surg Oncol 1991;17:466–76.
Rosen PP, Senie R, Schottenfeld D, Ashikari R. Noninvasive breast carcinoma: frequency of unsuspected invasion and implications for treatment.Ann Surg 1979;189:377–82.
Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ: relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures.Cancer 1982;50:1309–14.
Ottesen GL, Graversen HP, Blichert-Toft M, Zedeler K, Andersen JA. Ductal carcinoma in situ of the female breast: short-term results of a prospective nationwide study.Am J Surg Pathol 1992;16:1183–96.
Silverstein MJ, Cohlan BF, Gierson ED, et al. Duct carcinoma in situ: 227 cases without microinvasion.Eur J Cancer 1992;28:630–4.
McCormick B, Rosen PP, Kinne DE, Cox L, Yahalom J. Duct carcinoma in situ of the breast: an analysis of local control after conservation surgery and radiotherapy.Int J Radiat Oncol Biol Phys 1991;21:289–92.
Solin LJ, Yeh I, Kurtz J, et al. Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation.Cancer 1993;71:2532–42.
Solin LJ, Kurtz J, Fourquet A, et al. Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast.J Clin Oncol 1996;14:754–63.
Cataliotti L, Distante V, Ciatto S, et al. Intraductal breast cancer: review of 183 consecutive cases.Eur J Cancer 1992;28A:917–20.
Solin LJ, Yeh I, Kurtz J, et al. Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation: correlation of pathologic parameters with outcome of treatment.Cancer 1993;71:2532–42.
Silverstein MJ, Poller DN, Barth A, et al. Intraductal breast carcinoma: experiences from The Breast Center in Van Nuys, California.Recent Results Cancer Res 1996;140:139–53.
Holland R, Hendriks JHCL, Verbeek ALM, Mravunac M, Stekhoven JHS. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ.Lancet 1990;335:519–22.
Farrow JH. Current concepts in the detection and treatment of the earliest of the early breast cancers.Cancer 1970;25:468–77.
Millis RR, Thynne GSJ. In situ intraduct carcinoma of the breast: a long-term follow-up study.Br J Surg 1975;62:957–62.
Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected duct carcinoma in situ: frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence.Cancer 1989;63:618–24.
Gallagher WJ, Koerner FC, Wood WC. Treatment of intraductal carcinoma with limited surgery: long-term follow-up.J Clin Oncol 1989;7:376–80.
White J, Levine A, Gustafson G, et al. Outcome and prognostic factors for local recurrence in mammographically detected ductal carcinoma in situ of the breast treated with conservative surgery and radiation therapy.Int J Radiat Oncol Biol Phys 1995;31:791–7.
Silverstein MJ, Barth A, Poller DN, Gierson ED, Colburn WJ, Waisman JR, Gamagami P. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast.Eur J Cancer 1995;31A:1425–7.
Vicini FA, Eberlein TJ, Connolly JL, et al. The optimal extent of resection for patients with stages I or II breast cancer treated with conservative surgery and radiotherapy.Ann Surg 1991;214:200–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hwang, ES., Samli, B., Tran, K.N. et al. Volume of resection in patients treated with breast conservation for ductal carcinoma in situ. Annals of Surgical Oncology 5, 757–763 (1998). https://doi.org/10.1007/BF02303488
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02303488