Ductal intraepithelial neoplasia: Postsurgical outcome for 1,267 women cared for in one single institution over 10 years

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Abstract

Introduction. Diagnosis of breast ductal intraepithelial neoplasia (DIN) has increased over the last decades, but proper postsurgical treatment remains controversial. We analyzed risk factors and treatment outcome in a large series of women treated at one institution. Methods. Women undergoing surgery for DIN at the European Institute of Oncology between 1996 and 2005, with follow-up until December 2006, were included. Results. We evaluated the postsurgical treatment outcome of 974 and 293 patients who underwent breast-conserving surgery (BCS) or mastectomy, respectively. The 5-year cumulative incidence of breast cancer (BC) events was 11.8%, with a significant trend according to age (from 43% in women 65 years). Among the 727 BCS patients with DIN2-DIN3 histology, 414 (57%) received radiotherapy (RT), and they were both younger and with worse prognostic factors than the 313 patients who did not receive it. In these groups, the adjusted hazard ratio (HR) for RT versus non-RT was 0.40 (95% confidence interval [CI], 0.26-0.63). Among the 691 BCS patients with estrogen receptor (ER) + disease, 329 (48%) received low-dose tamoxifen (either 5 mg/day or 20 mg once a week) and they were younger than the 362 who did not receive it. In these groups, the adjusted HR for tamoxifen versus no tamoxifen was 0.68 (95% CI, 0.43-1.07), and the HR was 0.55 (95% CI, 0.32-0.97) after excluding human epidermal growth factor receptor (HER)2/neu-overexpressing DIN. Conclusions. BC events were more frequent in young patients. RT was associated with a lower incidence of BC events. Low-dose tamoxifen was associated with a lower incidence of BC events in patients with ER + disease when HER-2 was not overexpressed. Further prospective studies should confirm our observations.

Original languageEnglish
Pages (from-to)201-212
Number of pages12
JournalThe oncologist
Volume14
Issue number3
DOIs
Publication statusPublished - Mar 2009

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Tamoxifen
Segmental Mastectomy
Breast Neoplasms
Neoplasms
Radiotherapy
Confidence Intervals
Estrogen Receptors
Incidence
Mastectomy
Histology
Breast
Prospective Studies
Therapeutics

Keywords

  • Chemoprevention
  • Intraepithelial neoplasia
  • Radiotherapy
  • Tamoxifen

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

@article{20f88986cf3e41159c4feaf2df42a303,
title = "Ductal intraepithelial neoplasia: Postsurgical outcome for 1,267 women cared for in one single institution over 10 years",
abstract = "Introduction. Diagnosis of breast ductal intraepithelial neoplasia (DIN) has increased over the last decades, but proper postsurgical treatment remains controversial. We analyzed risk factors and treatment outcome in a large series of women treated at one institution. Methods. Women undergoing surgery for DIN at the European Institute of Oncology between 1996 and 2005, with follow-up until December 2006, were included. Results. We evaluated the postsurgical treatment outcome of 974 and 293 patients who underwent breast-conserving surgery (BCS) or mastectomy, respectively. The 5-year cumulative incidence of breast cancer (BC) events was 11.8{\%}, with a significant trend according to age (from 43{\%} in women 65 years). Among the 727 BCS patients with DIN2-DIN3 histology, 414 (57{\%}) received radiotherapy (RT), and they were both younger and with worse prognostic factors than the 313 patients who did not receive it. In these groups, the adjusted hazard ratio (HR) for RT versus non-RT was 0.40 (95{\%} confidence interval [CI], 0.26-0.63). Among the 691 BCS patients with estrogen receptor (ER) + disease, 329 (48{\%}) received low-dose tamoxifen (either 5 mg/day or 20 mg once a week) and they were younger than the 362 who did not receive it. In these groups, the adjusted HR for tamoxifen versus no tamoxifen was 0.68 (95{\%} CI, 0.43-1.07), and the HR was 0.55 (95{\%} CI, 0.32-0.97) after excluding human epidermal growth factor receptor (HER)2/neu-overexpressing DIN. Conclusions. BC events were more frequent in young patients. RT was associated with a lower incidence of BC events. Low-dose tamoxifen was associated with a lower incidence of BC events in patients with ER + disease when HER-2 was not overexpressed. Further prospective studies should confirm our observations.",
keywords = "Chemoprevention, Intraepithelial neoplasia, Radiotherapy, Tamoxifen",
author = "Aliana Guerrieri-Gonzaga and Edoardo Botteri and Nicole Rotmensz and Fabio Bassi and Mattia Lntra and Davide Serrano and Giuseppe Renne and Alberto Luini and Massimiliano Cazzaniga and Aaron Goldhirsch and Marco Colleoni and Giuseppe Viale and Giovanni Ivaldi and Vincenzo Bagnardi and Matteo Lazzeroni and Andrea Decensi and Umberto Veronesi and Bernardo Bonanni",
year = "2009",
month = "3",
doi = "10.1634/theoncologist.2008-0203",
language = "English",
volume = "14",
pages = "201--212",
journal = "Oncologist",
issn = "1083-7159",
publisher = "Wiley Blackwell",
number = "3",

}

TY - JOUR

T1 - Ductal intraepithelial neoplasia

T2 - Postsurgical outcome for 1,267 women cared for in one single institution over 10 years

AU - Guerrieri-Gonzaga, Aliana

AU - Botteri, Edoardo

AU - Rotmensz, Nicole

AU - Bassi, Fabio

AU - Lntra, Mattia

AU - Serrano, Davide

AU - Renne, Giuseppe

AU - Luini, Alberto

AU - Cazzaniga, Massimiliano

AU - Goldhirsch, Aaron

AU - Colleoni, Marco

AU - Viale, Giuseppe

AU - Ivaldi, Giovanni

AU - Bagnardi, Vincenzo

AU - Lazzeroni, Matteo

AU - Decensi, Andrea

AU - Veronesi, Umberto

AU - Bonanni, Bernardo

PY - 2009/3

Y1 - 2009/3

N2 - Introduction. Diagnosis of breast ductal intraepithelial neoplasia (DIN) has increased over the last decades, but proper postsurgical treatment remains controversial. We analyzed risk factors and treatment outcome in a large series of women treated at one institution. Methods. Women undergoing surgery for DIN at the European Institute of Oncology between 1996 and 2005, with follow-up until December 2006, were included. Results. We evaluated the postsurgical treatment outcome of 974 and 293 patients who underwent breast-conserving surgery (BCS) or mastectomy, respectively. The 5-year cumulative incidence of breast cancer (BC) events was 11.8%, with a significant trend according to age (from 43% in women 65 years). Among the 727 BCS patients with DIN2-DIN3 histology, 414 (57%) received radiotherapy (RT), and they were both younger and with worse prognostic factors than the 313 patients who did not receive it. In these groups, the adjusted hazard ratio (HR) for RT versus non-RT was 0.40 (95% confidence interval [CI], 0.26-0.63). Among the 691 BCS patients with estrogen receptor (ER) + disease, 329 (48%) received low-dose tamoxifen (either 5 mg/day or 20 mg once a week) and they were younger than the 362 who did not receive it. In these groups, the adjusted HR for tamoxifen versus no tamoxifen was 0.68 (95% CI, 0.43-1.07), and the HR was 0.55 (95% CI, 0.32-0.97) after excluding human epidermal growth factor receptor (HER)2/neu-overexpressing DIN. Conclusions. BC events were more frequent in young patients. RT was associated with a lower incidence of BC events. Low-dose tamoxifen was associated with a lower incidence of BC events in patients with ER + disease when HER-2 was not overexpressed. Further prospective studies should confirm our observations.

AB - Introduction. Diagnosis of breast ductal intraepithelial neoplasia (DIN) has increased over the last decades, but proper postsurgical treatment remains controversial. We analyzed risk factors and treatment outcome in a large series of women treated at one institution. Methods. Women undergoing surgery for DIN at the European Institute of Oncology between 1996 and 2005, with follow-up until December 2006, were included. Results. We evaluated the postsurgical treatment outcome of 974 and 293 patients who underwent breast-conserving surgery (BCS) or mastectomy, respectively. The 5-year cumulative incidence of breast cancer (BC) events was 11.8%, with a significant trend according to age (from 43% in women 65 years). Among the 727 BCS patients with DIN2-DIN3 histology, 414 (57%) received radiotherapy (RT), and they were both younger and with worse prognostic factors than the 313 patients who did not receive it. In these groups, the adjusted hazard ratio (HR) for RT versus non-RT was 0.40 (95% confidence interval [CI], 0.26-0.63). Among the 691 BCS patients with estrogen receptor (ER) + disease, 329 (48%) received low-dose tamoxifen (either 5 mg/day or 20 mg once a week) and they were younger than the 362 who did not receive it. In these groups, the adjusted HR for tamoxifen versus no tamoxifen was 0.68 (95% CI, 0.43-1.07), and the HR was 0.55 (95% CI, 0.32-0.97) after excluding human epidermal growth factor receptor (HER)2/neu-overexpressing DIN. Conclusions. BC events were more frequent in young patients. RT was associated with a lower incidence of BC events. Low-dose tamoxifen was associated with a lower incidence of BC events in patients with ER + disease when HER-2 was not overexpressed. Further prospective studies should confirm our observations.

KW - Chemoprevention

KW - Intraepithelial neoplasia

KW - Radiotherapy

KW - Tamoxifen

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U2 - 10.1634/theoncologist.2008-0203

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