Cancer recurrence in women with DCIS isn?t determined by age
BOSTON—A new study rebuffs conventional thinking that young women with ductal carcinoma in situ (DCIS) are presumed more likely to have recurrences than older women with the same diagnosis, according to research presented Wednesday at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

“There are discrepancies among past studies that looked at the outcomes of very young women with DCIS treated with radiation, but many suggested a less favorable outcome than for older women,” said Aruna Turaka, MD, a fellow in the department of radiation oncology at Fox Chase Cancer Center in Philadelphia. "Because each of these studies reflects diverse factors, including how the cancer was managed by the surgeons and radiation oncologists, we wanted to look at our institution's experience in treating DCIS in this population.”

For the study, physicians examined the records of 440 patients with DCIS treated from 1978 to 2007 at Fox Chase. Of these, 24 patients were 40 years old or younger. The researchers excluded patients with invasive disease or more than one area involved in the breast re-excision to obtain wider clear margins was used in 62 percent of all patients, and even more often—75 percent—in patients 40 or younger.

According to the investigators, all women received whole-breast radiotherapy and 95 percent also received a radiation boost. Data analyzed included method of presentation, patient and DCIS characteristics, and surgical and adjuvant treatment. The median follow-up was 6.8 years, and the median age was 56.5 years. 

“We didn't find a significant difference in recurrence rates based on age,” Turaka said. “Our study suggests that when treating DCIS with breast-conserving surgery and radiation, very young age plays a smaller role as a contributor to local recurrence than previously suggested.”

Turaka reported that local recurrence for all women was 7 percent at 10 years and 8 percent at 15 years. At 15 years, the recurrence rate was 10 percent in patients 40 or younger, 7 percent in those ages 41 to 54, 11 percent in those ages 55 to 69, and 4 percent in those 70 and older. The different recurrence rates were not statistically significantly.

Turaka and colleagues concluded that these “results are specific to one institution. The reasons for the low rates of recurrence in young women could be related to the careful patient selection and a high utilization of surgical re-excision and a radiation boost.”