Long-term risk of subsequent ipsilateral lesions after surgery with or without radiotherapy for ductal carcinoma in situ of the breast

• Published in: British journal of cancer Vol. 125; no. 10; pp. 1443 - 1449
• Main Authors: van Seijen, Maartje, Lips, Esther H., Fu, Liping, Giardiello, Daniele, van Duijnhoven, Frederieke, de Munck, Linda, Elshof, Lotte E., Thompson, Alastair, Sawyer, Elinor, Ryser, Marc D., Hwang, E. Shelley, Schmidt, Marjanka K., Elkhuizen, Paula H. M., Wesseling, Jelle, Schaapveld, Michael
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09-11-2021; Nature Publishing Group
• Subjects: 631/67/1059/485; 692/308/409; 692/4028/67/1347; 692/4028/67/2324; Adult; Aged; Biomedical and Life Sciences; Biomedicine; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer Research; Carcinoma, Intraductal, Noninfiltrating - epidemiology; Carcinoma, Intraductal, Noninfiltrating - radiotherapy; Carcinoma, Intraductal, Noninfiltrating - surgery; Clinical trials; Cohort Studies; Drug Resistance; Epidemiology; Female; Humans; Incidence; Invasiveness; Middle Aged; Molecular Medicine; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - radiotherapy; Neoplasms, Second Primary - surgery; Netherlands - epidemiology; Oncology; Radiation therapy; Surgery; Netherlands
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-021-01496-6

Background
Radiotherapy (RT) following breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) reduces ipsilateral breast event rates in clinical trials. This study assessed the impact of DCIS treatment on a 20-year risk of ipsilateral DCIS (iDCIS) and ipsilateral invasive breast cancer (iIBC) in a population-based cohort.
Methods
The cohort comprised all women diagnosed with DCIS in the Netherlands during 1989–2004 with follow-up until 2017. Cumulative incidence of iDCIS and iIBC following BCS and BCS + RT were assessed. Associations of DCIS treatment with iDCIS and iIBC risk were estimated in multivariable Cox models.
Results
The 20-year cumulative incidence of any ipsilateral breast event was 30.6% (95% confidence interval (CI): 28.9–32.6) after BCS compared to 18.2% (95% CI 16.3–20.3) following BCS  +  RT. Women treated with BCS compared to BCS + RT had higher risk of developing iDCIS and iIBC within 5 years after DCIS diagnosis (for iDCIS: hazard ratio (HR)
age < 50
3.2 (95% CI 1.6–6.6); HR
age ≥ 50
3.6 (95% CI 2.6–4.8) and for iIBC: HR
age<50
2.1 (95% CI 1.4–3.2); HR
age ≥ 50
4.3 (95% CI 3.0–6.0)). After 10 years, the risk of iDCIS and iIBC no longer differed for BCS versus BCS + RT (for iDCIS: HR
age < 50
0.7 (95% CI 0.3–1.5); HR
age ≥ 50
0.7 (95% CI 0.4–1.3) and for iIBC: HR
age < 50
0.6 (95% CI 0.4–0.9); HR
age ≥ 50
1.2 (95% CI 0.9–1.6)).
Conclusion
RT is associated with lower iDCIS and iIBC risk up to 10 years after BCS, but this effect wanes thereafter.