As the incidence of ductal carcinoma in situ (DCIS) has increased, so has the number of DCIS survivors.1 Most patients with DCIS are treated with breast-conserving surgery (BCS).2 Radiation therapy (RT) and antiestrogen therapy (AET) have been shown to reduce the risk of recurrence,3,4 and are recommended by the NCCN Guidelines.5 However, relative survival remains extremely high (>98%) with or without these additional treatments.6–11 Some providers and patients believe the benefits of RT and AET are not meaningful enough to warrant their potential adverse effects. Not surprisingly, patterns of use for these treatment options vary, suggesting that there still is not universal consensus regarding optimal treatment of DCIS.12,13
DCIS survivors are at increased risk for developing second breast events (SBEs).9,14–16 Recently, we compared the pathologic characteristics of initial DCIS and SBEs in 2 separate data sets, and found similarities with respect to grade and hormone receptor (HR) status.17,18 Studies suggest that approximately half of all SBEs are invasive.14–16 Compared with patients first diagnosed with breast cancer, those with SBEs tend to be older and have more comorbid conditions, and may have a greater risk of distant recurrence.17 Unfortunately, relatively little is known regarding the optimal approach to treating SBEs. Should we extrapolate from studies of patients with newly diagnosed DCIS/cancer, or do the unique aspects of SBEs necessitate different treatment approaches? How do treatments provided for an initial DCIS, which can be quite variable, impact treatments offered to patients who develop an SBE?
Using a large cohort of patients who underwent BCS for DCIS, we sought to describe the treatments provided to patients who experienced an SBE and to identify independent determinants of mastectomy or AET for SBEs. We hypothesized that younger patients and those who received RT or AET for their initial DCIS treatment could be more likely to receive mastectomy or AET for their SBE therapy. Moreover, patients who received no RT for their initial DCIS could be less like to receive potentially beneficial treatments for their SBE.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
This study was supported by contract # HHSA290200500161 from AHRQ. Dr. Hassett received salary support from a Susan G. Komen for the Cure Career Catalyst Award. The views expressed in this article are those of the authors, and no official endorsement by AHRQ or the U.S. Department of Health and Human Services is intended or should be inferred.
See JNCCN.org for supplemental online content.
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