Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy Review


Authors: Pawloski, K. R.; Tadros, A. B.; Sevilimedu, V.; Newman, A.; Gentile, L.; Zabor, E. C.; Morrow, M.; Van Zee, K. J.; Kirstein, L. J.
Review Title: Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy
Abstract: Purpose: Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods: From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results: 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions: Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS. © 2021, The Author(s).
Keywords: breast cancer; mastectomy; ductal carcinoma in situ; invasive recurrence; breast-conservation surgery
Journal Title: Breast Cancer Research and Treatment
Volume: 186
Issue: 3
ISSN: 0167-6806
Publisher: Springer  
Date Published: 2021-04-01
Start Page: 617
End Page: 624
Language: English
DOI: 10.1007/s10549-021-06129-3
PUBMED: 33675490
PROVIDER: scopus
PMCID: PMC8019411
DOI/URL:
Notes: Review -- Export Date: 3 May 2021 -- Source: Scopus
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MSK Authors
  1. Monica Morrow
    725 Morrow
  2. Kimberly J Van Zee
    289 Van Zee
  3. Emily Craig Zabor
    172 Zabor
  4. Audree Blythe Tadros
    88 Tadros
  5. Ashley M Newman
    7 Newman