This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vicini, F. A. Articles by Martinez, A. A. Search for Related Content PubMed PubMed Citation Articles by Vicini, F. A. Articles by Martinez, A. A.

Impact of Young Age on Outcome in Patients With Ductal Carcinoma-In-Situ Treated With Breast-Conserving Therapy

From the Departments of Radiation Oncology, Anatomic Pathology, and Surgery, William Beaumont Hospital, Royal Oak, MI.

Address reprint requests to Frank A. Vicini, MD, Department of Radiation Oncology, William Beaumont Hospital, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073; email fvicini{at}beaumont.edu

PURPOSE: We reviewed our institution’s experience treating patients with ductal carcinoma-in-situ (DCIS) with breast-conserving therapy (BCT) to determine the impact of patient age on outcome.

PATIENTS AND METHODS: From 1980 to 1993, 146 patients were treated with BCT for DCIS. All patients underwent excisional biopsy, and 64% underwent re-excision. All patients received whole-breast irradiation to a median dose of 45 Gy. Ninety-four percent of patients received a boost to the tumor bed, for a median total dose of 60.4 Gy. All slides on every patient were reviewed by one pathologist. The median follow-up period was 7.2 years.

RESULTS: Seventeen patients developed an ipsilateral local recurrence, for 5- and 10-year actuarial rates of 10.2% and 12.4%, respectively. The 10-year rate of ipsilateral failure was 26.1% in patients younger than 45 years of age versus 8.6% in older patients (P = .03). On multivariate analysis, young age was independently associated with recurrence of the index lesion (true recurrence/marginal miss [TR/MM] failures), regardless of how it was analyzed (eg, < 45 years of age or as a continuous variable). In addition, young patients had a dramatically higher 10-year rate of invasive TR/MM failures (19.9% v 3.2%). In a separate multivariate analysis for the development of invasive TR/MM failures, only patient age and predominant nuclear grade were independently associated with recurrence. The relationship between excision volume and outcome was analyzed in the 95 patients who underwent re-excision. The 5-year actuarial rate of TR/MM failure was significantly worse only in young patients with smaller (< 40 mL) re-excision volumes (33.3% v 9.1%; P = .02). In a separate multivariate analysis of only these 95 patients (25 of whom were < 45 years of age), the volume of re-excision had the strongest association with outcome (P = .05). Patient age was no longer associated with local recurrence.

CONCLUSION: These findings suggest that young patients with DCIS have a significantly greater risk of local recurrence after BCT that is independent of other previously defined risk factors. Our data also suggest that the extent of resection may in part be related to the less optimal results that are observed in these patients.

This article has been cited by other articles:

				B G Haffty, A Silber, E Matloff, J Chung, and D Lannin Racial differences in the incidence of BRCA1 and BRCA2 mutations in a cohort of early onset breast cancer patients: African American compared to white women J. Med. Genet., February 1, 2006; 43(2): 133 - 137. [Abstract] [Full Text] [PDF]

				H. J. Burstein, K. Polyak, J. S. Wong, S. C. Lester, and C. M. Kaelin Ductal Carcinoma in Situ of the Breast N. Engl. J. Med., April 1, 2004; 350(14): 1430 - 1441. [Full Text] [PDF]

				K. Kerlikowske, A. Molinaro, I. Cha, B.-M. Ljung, V. L. Ernster, K. Stewart, K. Chew, D. H. Moore II, and F. Waldman Characteristics Associated With Recurrence Among Women With Ductal Carcinoma In Situ Treated by Lumpectomy J Natl Cancer Inst, November 19, 2003; 95(22): 1692 - 1702. [Abstract] [Full Text] [PDF]

				F. A. Vicini and A. Recht Age at Diagnosis and Outcome for Women With Ductal Carcinoma-In-Situ of the Breast: A Critical Review of the Literature J. Clin. Oncol., June 1, 2002; 20(11): 2736 - 2744. [Abstract] [Full Text] [PDF]

				N. Bijker, J. L. Peterse, L. Duchateau, J.-P. Julien, I. S. Fentiman, C. Duval, S. Di Palma, J. Simony-Lafontaine, I. de Mascarel, and M. J. van de Vijver Risk Factors for Recurrence and Metastasis After Breast-Conserving Therapy for Ductal Carcinoma-In-Situ: Analysis of European Organization for Research and Treatment of Cancer Trial 10853 J. Clin. Oncol., April 15, 2001; 19(8): 2263 - 2271. [Abstract] [Full Text] [PDF]