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New Research in JNCCN Offers Reassurance about Rarity of Recurrence for Early-Stage Breast Cancer after Breast-Conserving Surgery
Researchers from Dana-Farber Cancer Institute find less than three percent of women treated for early-stage breast cancer go on to develop invasive breast cancer; but raise survival concerns for some treated with radiation therapy.
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Top: Puyao C. Li, MD Bottom: Rinaa S. Punglia, MD, MPH, both from Dana-Farber Cancer Institute |
PLYMOUTH MEETING, PA [November 25, 2019] — New research in the November 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network examines the implications of invasive breast cancer after breast-conserving treatment for ductal carcinoma in situ (aka DCIS, a form of non-invasive breast cancer) and which factors could impact overall survival. The findings can help patients with decision-making for local treatment based on long-term outcomes and consideration of which recurrences may warrant a more aggressive treatment approach.
“We think it’s critical for physicians and patients to have a careful discussion weighing the pros and cons and individual patient characteristics and preferences before selecting treatment for DCIS,” said lead author Rinaa S. Punglia, MD, MPH, Dana-Farber Cancer Institute/Brigham and Women’s Hospital. “Our results provide additional factors for them to consider, especially for younger patients without estrogen receptor (ER) expression, where radiation therapy could limit salvage options in the future if the disease returns.”
“It is reassuring that overall, secondary invasive breast cancer following breast conserving therapy for DCIS is very low,” commented Janice Lyons, MD, Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Breast Cancer who was not involved with this research. “We know that adjuvant radiotherapy following breast conserving surgery for DCIS substantially reduces the risk of subsequent invasive disease on the same side. However, this study suggests that for those who do develop an invasive secondary breast cancer on the same side, treatment may be more challenging. I agree that a thoughtful discussion with each patient, incorporating shared decision-making and all available clinicopathologic information, is important to determine the preferred treatment approach for DCIS.”
The researchers used the National Cancer Institute’s Surveillance, Epidemiology, and End Result (SEER) database to study 3,407 patients who were treated with breast-conserving surgery (with or without radiation therapy) for DCIS between 2000 and 2013, and subsequently developed a stage I-III invasive secondary breast cancer. Out of those 3,407 patients, 150 deaths were reported; 89 of them in patients who were initially treated with radiation therapy, and another 61 who were not.
The findings showed that those patients who developed a second cancer in the same breast were more likely to be younger, and to lack ER expression, which are characteristics associated with more aggressive cancers. However, this was not as evident in patients who developed a second cancer in the opposite breast. This is particularly significant because radiation is less likely to be an option when cancer returns to the same breast. The authors conclude that patients who develop an invasive recurrence in the same breast as their initial DCIS may benefit from intensified and aggressive treatment.
To read the entire study, visit JNCCN.org. Complimentary access to “Mortality after Invasive Second Breast Cancers Following Prior Radiotherapy for DCIS” is available until February 10, 2020.
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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit https://www.nccn.org/jnccn/subscribe.aspx. Follow JNCCN on Twitter @JNCCN.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.
The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCN, Facebook @NCCNorg, and Instagram @NCCNorg.