Long-Term Risks of Invasive Breast Cancer and Breast Cancer Mortality in Non-Screen Detected Ductal Carcinoma in Situ: A Cohort Study from 1990 to 2018 in England
.jpg)
Objective: This population-based cohort study aimed to assess the enduring risks of invasive breast cancer and breast cancer-related death in women with non-screen detected ductal carcinoma in situ (DCIS) from 1990 to 2018 in England. Comparative analyses were conducted between the general population and those diagnosed with DCIS through the national screening program.
Design: Utilizing data from the National Disease Registration Service, we conducted a comprehensive population-based cohort study.
Participants: The study included 27,543 women in England diagnosed with DCIS outside the NHS breast screening program during the period 1990 to 2018.
Main Outcome Measures: Incident invasive breast cancer and breast cancer-related mortality.
Results: By December 31, 2018, 3,651 women with non-screen detected DCIS had developed invasive breast cancer, surpassing the expected national cancer incidence rates by more than fourfold (observed-to-expected rate ratio 4.21, 95% confidence interval 4.07 to 4.35). The elevated observed-to-expected rate of developing invasive breast cancer persisted across all age groups from <45 to 70 years. The 25-year cumulative risks of invasive breast cancer varied by age at DCIS diagnosis: 27.3% (<45 years), 25.2% (45-49 years), 21.7% (50-59 years), and 20.8% (60-70 years). Additionally, 908 women died from breast cancer, nearly four times higher than expected from general population death rates (observed-to-expected rate ratio 3.83, 95% confidence interval 3.59 to 4.09). The observed-to-expected rate of breast cancer mortality remained elevated throughout follow-up. The 25-year cumulative risks of breast cancer death by age at DCIS diagnosis were 7.6% (<45 years), 5.8% (45-49 years), 5.9% (50-59 years), and 6.2% (60-70 years). Among women aged 50-64 years eligible for NHS breast screening, the observed-to-expected rate ratio for invasive breast cancer in non-screen detected compared with screen-detected DCIS was 1.26 (95% confidence interval 1.17 to 1.35), while the ratio for breast cancer mortality was 1.37 (1.17 to 1.60). In the subgroup of 22,753 women with unilateral DCIS undergoing surgery, those opting for mastectomy had a lower 25-year cumulative rate of ipsilateral invasive breast cancer (mastectomy 8.2%, 95% confidence interval 7.0% to 9.4%; breast conserving surgery with radiotherapy 19.8%, 16.2% to 23.4%; breast conserving surgery with no recorded radiotherapy 20.6%, 18.7% to 22.4%). However, this reduction did not translate into a lower 25-year cumulative rate of deaths attributable to breast cancer (mastectomy 6.5%, 4.9% to 10.9%; breast conserving surgery with radiotherapy 8.6%, 5.9% to 15.5%; breast conserving surgery with no recorded radiotherapy 7.8%, 6.3% to 11.5%).
Conclusions: Women with non-screen detected DCIS face elevated long-term risks of invasive breast cancer and breast cancer-related death for at least 25 years post-diagnosis, surpassing both the general population and those with screen-detected DCIS. Mastectomy is associated with lower risks of invasive breast cancer compared to breast conserving surgery, even when combined with radiotherapy. However, the risks of breast cancer death appear comparable across the three surgical approaches.
Comments
Post a Comment