Contralateral breast cancer risk in women with ductal carcinoma in situ: Is it high enough to justify bilateral mastectomy? Journal Article


Authors: Miller, M. E.; Muhsen, S.; Olcese, C.; Patil, S.; Morrow, M.; Van Zee, K. J.
Article Title: Contralateral breast cancer risk in women with ductal carcinoma in situ: Is it high enough to justify bilateral mastectomy?
Abstract: Background: Women with ductal carcinoma in situ (DCIS) are increasingly choosing bilateral mastectomy. We sought to quantify rates of contralateral breast cancer (CBC) and ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) for DCIS, and to compare risk factors for CBC and IBTR. Methods: From 1978 to 2011, DCIS patients undergoing BCS with a contralateral breast at risk were identified from a prospectively maintained database. The association of clinicopathologic and treatment factors with CBC and IBTR were evaluated using Kaplan–Meier analysis, multivariable Cox regression, and competing risk regression (CRR). Results: Of 2759 patients identified, 151 developed CBC and 344 developed IBTR. Five- and 10-year Kaplan–Meier CBC rates were 3.2 and 6.4%. Overall, 10-year IBTR rates were 2.5-fold higher than CBC rates, and, without radiation, 4-fold higher. On CRR, 5- and 10-year rates were 2.9 and 5.8% for CBC, and 7.8 and 14.5% for IBTR. CBC risk and invasive CBC risk were not significantly associated with age, family history, presentation, nuclear grade, year of surgery, or radiation. By multivariable Cox regression, endocrine therapy was associated with lower CBC risk (hazard ratio 0.57, p = 0.03). Ten-year risk of subsequent CBC in the subset of patients who developed IBTR was similar to the cohort as a whole (8.1 vs. 6.4%). Conclusions: CBC rates were low across all groups, including those who experienced IBTR. CBC was not associated with factors that increase IBTR risk. While factors associated with IBTR risk are important in decision making regarding management of the index DCIS, they are not an indication for contralateral prophylactic mastectomy. © 2017, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 24
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2017-10-01
Start Page: 2889
End Page: 2897
Language: English
DOI: 10.1245/s10434-017-5931-2
PROVIDER: scopus
PUBMED: 28766208
PMCID: PMC5728655
DOI/URL:
Notes: Article -- Export Date: 4 October 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Sujata Patil
    427 Patil
  2. Monica Morrow
    484 Morrow
  3. Kimberly J Van Zee
    250 Van Zee
  4. Shirin Muhsen
    28 Muhsen
  5. Cristina Olcese
    22 Olcese
  6. Megan Elizabeth Miller
    2 Miller