Mortality Among Women With Ductal Carcinoma In Situ of the 

Breast in the Population-Based Surveillance, Epidemiology 

and End Results Program



5/06 UPDATE: Lumpectomy as good as Mastectomy with DCIS - see study below (click on section)

1/04 UPDATE: Another study confirms that there is NO value in axillary node dissection with DCIS.

Ann's NOTE: FDA issued warnings and had Astra Zeneca (maker of Tamoxifen/Novaldex) on dangers of this drug for women with DCIS. The risks have been rated much higher. Please note this and have a full and frank discussion with your doctor if s/he suggests the use of Tamoxifen after diagnosis. Do not allow casual OVERTREATMENT. There may be serious health repercussions.

The following comes from the FDA site MEDWATCH (5/15/02): http://www.fda.gov/medwatch/SAFETY/2002/safety02.htm#nolvad

Nolvadex [tamoxifen citrate]

Audience: Oncologists and other healthcare professionals caring for women with breast cancer

FDA and AstraZeneca added a boxed warning and strengthened the WARNINGS section of the label to inform healthcare professionals about new risk information of particular relevance to women with ductal carcinoma in situ [DCIS] and women at high risk for developing breast cancer and are receiving or considering Nolvadex therapy to reduce their risk of developing invasive breast cancer.



Mortality Among Women With Ductal Carcinoma In Situ of the Breast in the Population-Based Surveillance, Epidemiology and End Results Program

Virginia L. Ernster, PhD; John Barclay, MS; Karla Kerlikowske, MD; Heather Wilkie, BA; Rachel Ballard-Barbash, MD

Background Over 14% of breast cancers diagnosed in the United States annually are ductal carcinomas in situ (DCIS). There are no published population-based reports of the likelihood of breast cancer death among US women with DCIS.

Methods We used data from the Surveillance, Epidemiology and End Results program to determine the likelihood of breast cancer death at 5 and 10 years among US women aged 40 and older diagnosed with DCIS from 1978 to 1983 (before screening mammography was common; n=1525) and from 1984 to 1989 (when screening mammography became common; n=5547). We also calculated standardized mortality ratios (SMRs) to compare observed deaths from breast cancer, cardiovascular disease, and all causes combined among women with DCIS with deaths expected based on general population mortality rates.

Results Among women diagnosed with DCIS from 1978 to 1983, 1.5% died of breast cancer within 5 years and 3.4% within 10 years. Among women diagnosed from 1984 to 1989, 0.7% died of breast cancer within 5 years and 1.9% within 10 years. Relative to the general population, risk of breast cancer death was greater for women diagnosed from 1978 to 1983 (SMR, 3.4; 95% confidence interval [CI], 2.5-4.5) than for women diagnosed from 1984 to 1989 (10-year SMR, 1.9; 95% CI, 1.5-2.3). Women diagnosed from 1984 to 1989 were significantly less likely than women in the general population to have died of cardiovascular diseases (10-year SMR, 0.6; 95% CI, 0.5-0.7) or of all causes combined (SMR, 0.8; 95% CI, 0.7-0.8).

Conclusions Among women diagnosed with DCIS, risk of death from breast cancer was low, at least within the 10 years following diagnosis. This may reflect the effectiveness of treatment for DCIS, the "benign" nature of DCIS, or both. At 10 years, women diagnosed from 1984 to 1989 were less likely than women diagnosed from 1978 to 1983 to have died of breast cancer, and their risk of dying of all causes combined was lower than that in the general population.

Arch Intern Med. 2000;160:953-958

Ann's NOTE: The conclusion here is enough to make anyone an ADVOCATE. All these years DCIS has been treated with a mastectomy. Even years after lumpectomy was shown to be good for invasive cancer, women with a much lesser disease were getting more extensive surgery. STUDIES MUST BE DONE FOR DCIS.

We have just posted a patient perspective where lumpectomy is critized as the wrong treatment (3/02)


Lumpectomy=Mastectomy for DCIS

May 2006 American Roentgen Ray Society

Salvage Treatment

Int'l Journal of Cancer, March 01

7th International Conference on Adjuvant Therapy

Lots of information from European experts, (for doctors but we ought to know)

References from the Conference
Risk Factors Subseq Invasive Bca

Cancer Epidemiology, Biomarkers & Prevention, May 2001

New Concept on Disease Progression
Patient Perspective
DCIS with Stage 1 Improved Prognosis
Occult Axillary Micromets:DCIS
Risk of Contralateral BCa w/DCIS or LCIS
Grade Recurrent In Situ/Invasiv Ca After DCIS
Young Women w/DCIS not more likely to Recur
Management of DCIS

Review of K A Skinner and M J Silverstein

Comparison of Strategies
Canada: Clinical Practice Guidelines
Sentinel Node Biopsy for DCIS Pts
Tumor Markers Correlate w/Grade

British J of Cancer, 9/14/01

Histological Subtypes
DCIS w/Microinvasion-Significance
Casting-type Calcifications w/Invasion-High Grade
Current Treatment of DCIS

1/02 The Breast Journal

Lymphatic Mapping in DCIS
VERY IMPORTANT-Cytokeratin+ cells in Lymph Nodes
Lifetime Recreational Exercise Reduces Risk of DCIS
Value of Lumpectomy Margin Assess

Cancer, 4/02

LCIS

Breast Cancer Research & Treatment, 9/02

LCIS & Invasive/Contralateral
DCIS Diagnosed 20% of Time

JNCI,10/02

Mucinous Cancers

Breast Cancer Research & Treatment, 11/02

Outcomes in Tubular/Muscinous/Medullary
Ductal Hyperplasia Different From Atypical/DCIS
Mucoepidermoid Carcinoma of the Breast
Retrospective review w/ long term follow up 11.400 cases pure mucinous breast ca
Metaplastic Bca: Path/Outcomes

Anticancer Res, 1-2/03

Metaplastic BCa: Clinical Traits/Outcomes
Squamous Cell Ca of the Breast

Euro J Sug Onc, 5/03

Smoking & Radiation Therapy

Cancer, 10/03

DCIS Cancer

LINK to website with information only on DCIS

DCIS Issues - SABCS 2006

2006, various abstracts

Breast density as a predictor of invasive events after treatment for ductal carcinoma in situ
No RTx for DCIS: 5 Yr Results
Recurrence Rates (DCIS) w/Lumpectomy...
HER2/neu a predictor for invasive recurrence: DCIS

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