Does Radiotherapy for DCIS Increase Risk of Mortality After Developing a Second Breast Cancer?
BACKGROUND AND PURPOSE:
Women with ductal carcinoma in situ (DCIS) are at increased risk for developing a second breast cancer (SBC)
RT may carry risk for increased mortality following SBC
Li et al. (JNCCN, 2019) studied the impact of RT for DCIS on mortality after SBC
Retrospective cohort study
Based on SEER database
≥41 years of age
Received breast-conserving therapy with or without RT for primary DCIS (2000 through 2013)
Subsequently developed a stage I-III invasive SBC within the same time period
Risk models were used to study the association between receipt of RT and mortality after SBC
Mortality after SBC
91,104 women with DCIS received breast-conserving surgery (± RT) | 3,407 women had subsequent SBC stage I-III
Prior RT was found to be associated with higher rates of breast cancer-specific mortality
Hazard ratio (HR) 1.70 (95% CI, 1.18 to 2.45; P=0.005)
Not impacted by cancer stage
The risk trended higher in patients with ipsilateral versus contralateral SBC
HR 2.07 (ipsilateral) vs 1.26 (contralateral); P=0.16
Patients who received RT for DCIS had higher mortality after developing a subsequent invasive SBC vs the group that did not receive RT
Results confirm the trend found in the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analysis
In women who did receive RT for DCIS, there was fewer incidences of SBC after RT in the ipsilateral breast, but there was still an increase in breast cancer–specific mortality after RT
The authors note that
One factor likely contributing to the finding of increased mortality associated with ipsilateral SBC after prior RT is that prior radiation to the ipsilateral breast limits subsequent salvage options in the same breast
These findings may have implications for treatment decision-making in DCIS and after development of SBC, and highlight the value of a careful discussion with patients before treatment
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