The survival benefit offered by the surgical management of low-grade ductal carcinoma in situ of the breast.

Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy
Session Type and Session Title: 
Oral Abstract Session, Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy
Abstract Number: 


J Clin Oncol 33, 2015 (suppl; abstr 1006)
Yasuaki Sagara, William Thomas Barry, Melissa Anne Mallory, Stephanie M. Wong, Fatih Aydogan, Stephen DeSantis, Mehra Golshan; Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA; Harvard School of Public Health, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Abstract Disclosures


Background: The current management of ductal carcinoma in situ (DCIS) of the breast includes lumpectomy with/without whole breast radiation or mastectomy, however the magnitude of benefit for surgery has not been well established. We sought to identify the survival benefit conferred by surgical resection over non-operative management in patients with low-grade DCIS. Methods: We performed a retrospective longitudinal cohort study using the Surveillance Epidemiology and End Results database. Between 1988 and 2011, 57,222 eligible cases of DCIS were identified. Patients (pts) were divided into a surgery and a non-surgery group; propensity score weighting was used to balance clinico-pathologic factors between groups. Breast cancer specific and overall survival (BCSS/OS) were assessed using a log-rank test and Cox proportional hazards model. Results: Of 57,222 cases of DCIS, 56,053 cases (98.0%) received definitive surgery (lumpectomy: 34,439 pts, mastectomy: 16,334 pts) and 1,169 cases (2.0%) were managed non-operatively. The proportion of the following clinico-pathologic factors was higher in the non-surgery group compared to the surgery group: age > 60, diagnosis after year 2000, black race, low-grade DCIS and absence of radiation therapy. There were 576 breast cancer-specific deaths over the 72-month median follow-up period. The weighted ten-year BCSS for the surgery group was 98.5%, compared to 93.5% (p < 0.001) for the non-surgery group. Survival benefit for the surgery group differed by nuclear grade (p = 0.003). The weighted ten-year BCSS of low-grade DCIS was similar between patients managed with and without surgery (98.8% and 98.6%, respectively; p = 0.93). Conclusions: The survival benefit offered by surgery for DCIS varies by nuclear grade. In contrast to high/intermediate grade DCIS, definitive local therapy of low-grade DCIS does not offer a significant survival advantage over non-operative management.

Hazard ratio (HR) comparison between DCIS patients managed surgically versus non-operatively as adjusted by clinico-pathologic factors.

GradeBCSS Weighted HR95% CIOS Weighted HR95% CI
I0.880.21 - 3.710.860.53 - 1.40
II0.250.15 - 0.420.700.52 - 0.94
III0.160.11 - 0.230.400.32 - 0.51