Women With DCIS Live Longer Than General Population

Zosia Chustecka

January 30, 2017

AMSTERDAM — New data on survival in women who are diagnosed with ductal carcinoma in situ (DCIS) should reassure such patients that this diagnosis does not increase their risk of dying, say Dutch researchers.

In fact, the analysis showed that women older than 50 years who are diagnosed with DCIS are more likely to be alive 10 years after their diagnosis than women in the general population. They had a lower risk of dying from all causes, except for one — they were at an increased risk of dying from breast cancer.

But this risk of dying from breast cancer "is still very low," and breast cancer is not the main cause of death in this population, emphasized lead author Lotte Elshof, MD, epidemiologist at the Netherlands Cancer Institute, Amsterdam.

Overall, the absolute risk of dying from breast cancer after 10 years was 1.4% in women older than age 50 years and slightly higher, at 2.4%, in those younger than age 50.

"These data should reassure women who are diagnosed with DCIS," Dr Elshof said. They also contribute to the debate on overdiagnosis and overtreatment, she added.

DCIS is increasingly being diagnosed with mammography, and the diagnosis fills women with anxiety, Dr Elshof commented. There is often a misconception that they have invasive breast cancer and that they are going to die. "We wanted to give these women accurate information," she said.

The new findings were presented in a poster here at the European CanCer Organisation (ECCO) Congress 2017.

They come from an analysis of 10,000 women diagnosed with DCIS between 1989 and 2004, who were followed for a median of 10 years. Most of the women (80%) were older than age 50 years, and the median age was 57 years.

Outcomes

"It may seem surprising that this group of women had a lower mortality rate than the general population, " Dr Elshof commented, "but the majority had been diagnosed via breast screening, which suggests that they may be health conscious." These women were likely to have good health behavior, and with the diagnosis of DCIS they were likely to continue with this and maybe even increase their efforts to stay healthy, such as keeping a good weight and exercising, she suggested.

In fact, another researcher in the audience noted that their study in Germany had found a marked difference in health behavior between individuals who participate in cancer screening programs and those who do not, with a marked difference in mortality from all causes between the two.

Individuals who participate in cancer screening tend also to have a better socioeconomic status, another researcher noted.

"This is a nice study," commented Isabel Rubio, MD, chief of breast surgical oncology at the Vall D'Hebron Hospital in Barcelona, Spain, who was a poster presentation moderator. Other studies have also shown a very low absolute risk of breast cancer, and these data confirm the finding that women diagnosed with DCIS have a very low risk of dying from breast cancer, which should reassure women who receive this diagnosis, she said in an interview with Medscape Medical News.

There has been a huge increase in DCIS from screening, she said, and this is a problem with overdiagnosis, she says. She argues that it is not an issue of overtreatment because once this diagnosis is made, at present it has to be treated. There is a trend toward thinking about not treating these lesions, especially when they are low risk and indolent, but at present, this is still being explored in clinical trials. Ongoing studies have randomly assigned women with very-low-risk DCIS to surgery and treatment vs a watch-and-wait approach, but results from these trials will not be reported for some time yet — perhaps 5 years from now, at a best estimate, she said. "In the meantime, we treat all DCIS because we do not have sufficient information," she added.

Similar sentiments were expressed by Philip Poortmans, MD, president-elect of ECCO and head of radiation oncology at Radboud University Medical Center in Nijmegen, the Netherlands. These data are reassuring, both for survival and also "with regard to the potential for side effects," he said.

DCIS is usually treated with surgery followed by radiation (about half the current study participants were irradiated), which can potentially damage to the heart. Another poster at the meeting showed that women who received radiation for breast cancer were at increased risk for myocardial infarction.

But this study showed that women with DCIS had a lower risk of dying from cardiovascular disease than the general population, as well as from other causes, including digestive and respiratory diseases and cancers other than breast cancer.

"However, we have to recognize that in one fifth of patients who die, the cause is breast cancer, which is likely to result from progression of the DCIS they were diagnosed with," he cautioned. "We are eagerly waiting for the results of further research to identify the factors — including age, as clearly shown in this study — that contribute to the risk for recurrence and progression from DCIS for each individual patient."

The research was funded by Pink Ribbon and the Dutch Cancer Society.

European CanCer Organisation (ECCO) Congress 2017. Abstract 173. Presented January 28, 2017.

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