Breast-Conserving Surgery Alone for Ductal Carcinoma In Situ: Factors Associated with Increased Risk of Local Recurrence.

PURPOSE: This retrospective study was aimed at identifying clinicopathologic characteristics associated with an increased risk for ipsilateral local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) treated with wide local excision (WLE) alone without radiotherapy (RT).

METHODS: All patients with DCIS treated with WLE alone at the Beth Israel Deaconess Medical Center, Boston, MA, USA, between the years 2000 and 2010 were identified. We collected data on demographics, parity, personal or family history of breast cancer, exogenous hormone use, tobacco use, comorbidities, genetic mutation carrier status, imaging interval, and tumor-specific characteristics.

RESULTS: Overall, 222 patients were included in the study. Median follow-up time was 8 years. LR occurred in 9% of patients, with a recurrence rate of 11.3 per 1000 person-years. The risk of recurrence was lower for patients with nuclear grade (NG) I tumors than for patients with NG II or NG III tumors (3, 8.5, and 19%, respectively; p = 0.01). The median margin width was 1 mm in patients experiencing LR versus 1.8 mm in patients without LR (p = 0.3). Patients who had used exogenous hormones, or patients with a history of tobacco use, had higher rates of LR than those who did not, although the difference did not reach statistical significance.

CONCLUSIONS: Our data indicate that higher NG, narrower margin width, use of exogenous hormones, and smoking history may be associated with an increased risk of LR. The evaluation of these factors may be helpful when considering whether or not to use adjuvant RT for patients with DCIS.