Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Meena Moran

Subject Area(s)

Medicine

Abstract

PURPOSE: For DCIS patients eligible for breast conservation treatment (BCT),it remains unclear whether presenting with physical signs/symptoms (Phys) confers a worse long-term prognosis compared to mammographically-detected DCIS (Mam). The purpose of this study was to determine if any significant differences in clinical-pathologic features or outcomes exist between these 2 distinct DCIS presentations uniformly treated with breast-conserving surgery and adjuvant radiation.

METHODS AND MATERIALS: This study consists of 669 DCIS patients treated with BCT from 1974-2007 of which Phys=80 and Mam=589. Chart reviews were conducted for relevant clinical/pathologic/outcome parameters, and analyzed using SPSS V.16 after IRB approval was obtained.

RESULTS: Treatment parameters (i.e. the RT dose delivered, boost, rates of stereotactic biopsy, re-excision, node dissection) did not differ significantly between the 2 cohorts (p=NS). At a 60-month median follow-up, significant differences included: younger age at presentation (p<0.001), higher non-white race(p=0.041), larger tumor size(p=0.002), more 1st degree/2nd degree papillary histology(1st degree: p=0.001, 2nd degree: p=0.005) in the Phys cohort. As expected, mammograms were more likely to show mass/nodules/asymmetric densities, and less likely to show microcalcifications for the Phys vs. Mam group (p<0.0001). There were no differences in family history, multifocality, grade, necrosis or residual disease at re-excision, nodal involvement, or status of margins or ER/PR/HER-2 between the cohorts. The local relapse-free survival was similar at 5 years (100% vs. 96.9%, p=0.116) and 10 years (96.2% vs. 96.2%, p=0.906), with no significant overall survival difference at 10 years (97.5% vs. 95.9%, p=0.364) between the Phys and Mam patients, respectively. On multivariate analysis, presentation was not an independent predictor of local relapse-free survival or overall survival when accounting for race, tumor size, primary histology, mammogram appearance and adjuvant hormone treatment.

CONCLUSION: There are limited published data in BCT-eligible DCIS patients assessing the overall prognosis as a function of presentation. Our findings suggest that while some clinical- pathologic differences exist between patients presenting with physical signs/symptoms compared with those presenting with mammographically detected disease, long-term outcomes after BCT are similar. While additional follow-up is warranted, these findings should be re-assuring for Phy patients eligible for BCT.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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