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Epidemiology

Invasive recurrence after breast conserving treatment of ductal carcinoma in situ of the breast in the Netherlands: time trends and the association with tumour grade

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Abstract

Background

The first aim of this study was to examine trends in the risk of ipsilateral invasive breast cancer (iIBC) after breast-conserving surgery (BCS) of ductal carcinoma in situ (DCIS). A second aim was to analyse the association between DCIS grade and the risk of iIBC following BCS.

Patients and methods

In this population-based, retrospective cohort study, the Netherlands Cancer Registry collected information on 25,719 women with DCIS diagnosed in the period 1989–2021 who underwent BCS. Of these 19,034 received adjuvant radiotherapy (RT). Kaplan–Meier analyses and Cox regression models were used.

Results

A total of 1135 patients experienced iIBC. Ten-year cumulative incidence rates of iIBC for patients diagnosed in the periods 1989–1998, 1999–2008 and 2009–2021 undergoing BCS without RT, were 12.6%, 9.0% and 5.0% (P < 0.001), respectively. For those undergoing BCS with RT these figures were 5.7%, 3.7% and 2.2%, respectively (P < 0.001). In the multivariable analyses, DCIS grade was not associated with the risk of iIBC.

Conclusion

Since 1989 the risk of iIBC has decreased substantially and has become even lower than the risk of invasive contralateral breast cancer. No significant association of DCIS grade with iIBC was found, stressing the need for more powerful prognostic factors to guide the treatment of DCIS.

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Fig. 1: DCIS grade.
Fig. 2: Adjuvant radiotherapy.
Fig. 3: Cumulative incidence of ipsilateral invasive breast cancer for patients with DCIS according to period of diagnosis.
Fig. 4: Cumulative incidence of ipsilateral invasive breast cancer for patients with DCIS according to DCIS grade.

Data availability

All data supporting the findings in this study are presented in the manuscript and the supplementary information, and additional raw data can be made available via the NCR upon request and after approval of a study proposal.

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Acknowledgements

We thank the NCR for providing the data and their data managers for collecting the data. We thank Anita Botterweck, data analyst at Netherlands Comprehensive Cancer Organisation (IKNL), for the data selection and for providing the dataset.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Maastricht University, Maastricht, Netherlands

    Rebecca L. O’Leary & Adri C. Voogd

  2. Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands

    Lucien E. M. Duijm

  3. Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, Netherlands

    Liesbeth J. Boersma

  4. Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands

    Maurice J. C. van der Sangen

  5. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands

    Linda de Munck & Adri C. Voogd

  6. Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands

    Jelle Wesseling

  7. Department of Pathology, the Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, Netherlands

    Jelle Wesseling

  8. Department of Pathology, Leiden University Medical Center, Leiden, Netherlands

    Jelle Wesseling

  9. Department of Surgery, Catharina Hospital, Eindhoven, Netherlands

    Robert-Jan Schipper

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Contributions

Study design: ACV. Performed the research and collected data: RLOL, LEMD, LJB, RJS and ACV. Analysed the data: RLOL. Manuscript drafting: RLOL, LEMD, LJB, RJS and ACV. Provided discussion, critical feedback and manuscript editing: LEMD, LJB, MJCS, RJS, LM and JW.

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Correspondence to Adri C. Voogd.

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O’Leary, R.L., Duijm, L.E.M., Boersma, L.J. et al. Invasive recurrence after breast conserving treatment of ductal carcinoma in situ of the breast in the Netherlands: time trends and the association with tumour grade. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02785-6

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