Preoperative Delays in the Treatment of DCIS and the Associated Incidence of Invasive Breast Cancer

• Published in: Annals of surgical oncology 2020-02, Vol.27 (2), p.386-396
• Main Authors: Ward, William H., DeMora, Lyudmila, Handorf, Elizabeth, Sigurdson, Elin R., Ross, Eric A., Daly, John M., Aggon, Allison A., Bleicher, Richard J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Carcinoma, Ductal, Breast - epidemiology; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Clinical trials; Diagnosis; Female; Follow-Up Studies; Health risk assessment; Humans; Incidence; Invasiveness; Mastectomy - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Oncology; Patients; Population studies; Preoperative Care; Prognosis; Prospective Studies; Surgery; Surgical Oncology; Time-to-Treatment - statistics & numerical data; Young Adult
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-019-07844-4

Background Although treatment delays have been associated with survival impairment for invasive breast cancer, this has not been thoroughly investigated for ductal carcinoma in situ (DCIS). With trials underway to assess whether DCIS can remain unresected, this study was performed to determine whether longer times to surgery are associated with survival impairment or increased invasion. Methods A population-based study of prospectively collected national data derived from women with a clinical diagnosis of DCIS between 2004 and 2014 was conducted using the National Cancer Database. Overall survival (OS) and presence of invasion were assessed as functions of time by evaluating five intervals (≤ 30, 31–60, 61–90, 91–120, 121–365 days) between diagnosis and surgery. Subset analyses assessed those having pathologic DCIS versus invasive cancer on final pathology. Results Among 140,615 clinical DCIS patients, 123,947 had pathologic diagnosis of DCIS and 16,668 had invasive ductal carcinoma. For all patients, 5-year OS was 95.8% and unadjusted median delay from diagnosis to surgery was 38 days. With each delay interval increase, added relative risk of death was 7.4% (HR 1.07; 95% CI 1.05–1.10; P