DCIS recurrence rates higher in younger women

NEW YORK (Reuters Health) - Younger women who undergo breast-conserving surgery and radiotherapy for ductal carcinoma in situ (DCIS) are more likely to experience recurrence than are older women, according to the results of a large population-based study.

Among women who are no older than 50 years at diagnosis, those who are 44 years and younger have a recurrence rate of around 22% compared with a rate of 14% in older women (p = 0.01). The corresponding 10-year actuarial local-recurrence free survival (LRFS) rates are 75% and 85% (p = 0.005).

The study findings were presented Tuesday at a press briefing for the 2009 Breast Cancer Symposium, to be held later this week in San Francisco.

Prior research has shown that treatment of DCIS with breast-conserving surgery followed by radiotherapy can achieve low recurrence rates. "What is unclear is the significance of young age in DCIS," lead author Dr. Iwa Kong, from Odette Cancer Center, Toronto, told attendees. "Some studies have suggested that young women have higher recurrence rates."

The present study examined the outcomes of 583 Canadian women who were no more than 50 years of age when diagnosed with DCIS between 1994 and 2003 and who were treated with breast-conserving surgery and radiotherapy. The subjects were followed for a median of 8.5 years.

Most of the women received 50 Gy in 25 fractions, and 121 (21%) received a boost, the researchers note.

Overall, 99 women (17%) experienced a local recurrence. Five- and 10-year actuarial local recurrence-free survival (LRFS) rates were 88% and 81%, respectively. Invasive local recurrence developed in 38 women (6.5%), resulting in 5- and 10-year actuarial invasive LRFS rates of 95% and 93%, respectively.

The recurrence rates for women aged 40 years or less, and women ages 40 to 44 years, were 23% and 21%, respectively, while the rate for women ages 45 to 50 years was 14%.

"DCIS is a highly curable illness with good outcomes," Dr. Kong said. "However, our preliminary data suggest that young women have a higher risk of recurrence following lumpectomy and radiation." Further research is needed to understand the reason for this finding and to determine the optimal treatment for young women with DCIS, she added.

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