Study: All DCIS is not the same: Young women and African American women at higher risk after DCIS diagnosis
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This study is about:
Estimating breast cancer mortality after a diagnosis and identifying which factors, such as age, ethnicity, and initial treatment received, increase a patient’s risk of dying from breast cancer.
Why is this study important?
The study agrees with previous work that shows a low death rate from breast cancer after diagnosis. The study found a 3.3% risk of death from breast cancer after 20 years beyond a diagnosis. Finding common factors in women with who eventually died from breast cancer can help physicians learn who might benefit from more aggressive treatment, which will translate into helping patients and their doctors decide on the best course of treatment.
- The risk of dying from breast cancer 20 years after a diagnosis is low: 3.3% for all women.
- Women under age 35 at diagnosis and black women had the highest risk of death from breast cancer after 20 years (approximately 8% and 7%, respectively).
- Treatment with radiotherapy or mastectomy did not decrease breast cancer mortality.
What does this mean for me?
The study showed that the risk of dying from breast cancer after a diagnosis is generally low, and it opens the possibility of discussing less aggressive treatment alternatives with patients’ health care providers. However, the study identified two groups of women with higher breast cancer mortality after —young women who are diagnosed with breast cancer (under 40 years old) and African American women who are at higher risk of dying from breast cancer. It is important for women in these two groups to discuss treatment options and heightened surveillance with their health care providers.
Narod SA, Iqbal J, Glannakeas V, et al. “Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ.” JAMA Oncology, initially published online August 20, 2015.
Esserman L and Yau C. “Editorial: Rethinking the Standard for Ductal Carcinoma In Situ Treatment.” JAMA Oncology, Initially published online August 20, 2015.
Although cells are abnormal, they are not the same as invasive cancer cells. Unlike invasive cancer, lacks the ability to metastasize (spread to other areas of the body). Scientists long believed that untreated cells could turn into invasive cancer, which might then spread to other parts of the body and cause death. For this reason, lesions are generally removed and the remaining breast is treated with radiation to kill off any lingering cancer cells. However, data from previous studies and this more recent study show that even left untreated, seldom leads to death, and that removing does not help most women live longer. This study was done to learn which risk factors are associated with breast cancer mortality after a diagnosis.
Researchers of this study wanted to know:
How many women previously diagnosed with eventually die from breast cancer, and which women are at greatest risk for breast cancer death after .
Population(s) looked at in the study:
Data from approximately 108,000 women who were diagnosed with from 1988-2011 were obtained from the National Cancer Institute’s (Surveillance, Epidemiology and End Results) database. collects information on all patients diagnosed with cancer, including the site of the primary cancer; the of cancer at diagnosis, the first course of treatment; specific markers, such as , ER, and PR; and patient survival. Research using databases such as is useful in designing controlled studies that compare how different treatment options affect survival.
- 20 years after diagnosis, the breast cancer mortality rate was approximately 3% for all women.
- Women who were diagnosed with before age 35 had the highest risk of death from breast cancer after 20 years. The 20-year risk was still low (approximately 8%).
- Women who were diagnosed with between ages 35-39 had a 4.5% risk of developing invasive breast cancer after 20 years.
- On average, women who were diagnosed with between ages 40 and 69 had an approximate 3% risk of developing invasive breast cancer after 20 years.
- African American women had a 7% risk of death at 20 years after diagnosis, compared to 3% for white, non-Hispanic women.
- Radiotherapy after reduced the risk of developing an invasive recurrent breast cancer from about 5% to 2.5%. However, this reduction did not translate to a reduction in risk of death from breast cancer.
- Of the 956 women who died of breast cancer (out of 108,196 women total) after their diagnosis, most (approximately 55% of the 956 women) did not have a record of invasive in-breast recurrence.
Researchers were unable to tell which cases of were detected through screening and which cases were symptomatic. The researchers did not have access to information that could affect risk of recurrence and/or second primary breast cancer such as:
- tamoxifen use after
- body mass index
- family history of breast cancer
- the presence of mutations in or other genes associated with increased cancer risk
- whether or not the later invasive cancer was a recurrence of the original cancer or a new breast cancer in the same or opposite breast
This study highlights two populations who have a higher risk of breast cancer mortality after diagnosis: young women (under 40) and African American women. As breast surgeon Dr. Laura Esserman said in an editorial that was published on this study, “For young women (<40 years) who present with symptomatic —approximately 5% of the population—we should be cognizant that this is a different disease than typical .” Esserman noted that new tests that look at a patient’s tumor can help health care providers identify which patients with could benefit from more aggressive treatment.
This study did not look at patients’ status or their family history of breast cancer. While the study shows that the risk of dying from breast cancer after a diagnosis is generally low, young women and African American women should be monitored more regularly and more thoroughly. Women diagnosed with before the age of 50 meet national guidelines for referral to genetic services; they may wish to discuss the possibility of genetic counseling and/or testing with their health care provider.
Experts note that this study alone does not mean that doctors should stop treating women with DCIS; rather, it is an indicator for further discussion and research on how to best treat in different populations.
The National Comprehensive Cancer Network (NCCN) guidelines include the following options for treatment of DCIS:
- Breast-conserving therapy ( followed by radiation therapy) without lymph node surgery.
- Total mastectomy with or without lymph node surgery.
- Breast-conserving surgery without lymph node surgery followed by accelerated partial breast irradiation.
- Breast-conserving surgery without lymph node surgery (and without radiation therapy).
Following surgery, the NCCN recommends that patients:
- Consider endocrine therapy for 5 years for people with ER-positive who:
- received breast conservation and radiation therapy.
- were treated with surgical excision only.
- Receive counseling regarding risk reduction.
- What are the best options for treating my given my age and/or family background?
- Will my family history of cancer affect my treatment options for ?
- What other tests can be used to help decide how to treat my ?
- I was diagnosed with before age 50, should I consider genetic counseling or testing?
- What are my options for preventing a recurrence?
The following organizations offer peer support services for people with, or at high risk for breast cancer:
- FORCE peer support:
- Our Message Boards allow people to connect with others who share their situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Connect online with our Private Facebook Group.
- Join our virtual and in-person support meetings.
- Other organizations that offer breast cancer support:
Who covered this study?
New York Times
Decades of data fail to resolve debate on treating tiny breast lesions This article rates 4.0 out of 5 stars
New York Times:
Doubt Is raised over value of surgery for breast lesion at earliest stage This article rates 3.5 out of 5 stars
The San Diego Union Tribune
Study challenges status quo in breast cancer treatment This article rates 3.5 out of 5 stars
Study sparks debate on treatment for early stage breast cancer This article rates 3.5 out of 5 stars
Low rate of mortality from breast cancer after DCIS diagnosis This article rates 3.5 out of 5 stars