Trade-offs between survival and breast preservation for three initial treatments of ductal carcinoma-in-situ of the breast

B. E. Hillner, C. E. Desch, R. W. Carlson, Thomas J Smith, L. Esserman, H. D. Bear

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the trade-offs between survival and breast preservation of currently accepted approaches for ductal carcinoma-in-situ (DCIS) of the breast. Patients and Methods: Decision analysis was performed using the Markov model of hypothetical cohorts of 55-year-old white women with nonpalpable mammographic abnormalities found to be DCIS. Strategies were breast-conserving surgery (BCS), BCS with 50-Gy radiation (RT) or initial mastectomy. Recurrence rates were derived from the published literature. Main outcomes were overall, breast cancer-free, and event-free survival plus years of both breasts preserved. Results: Using the conditions defined in this model, the actuarial survival rates at 10 and 20 years were 91.7% and 74.1% for the initial mastectomy strategy, 91.0% and 72.1% for BCS plus RT, and 89.6% and 68.2% for BCS alone. At 20 years, the initial mastectomy strategy also had a greater breast cancer-free survival rate of 74.5%, compared with 63.3% for BCS plus RT, or 46.8% for BCS alone. However, BCS alone had the highest survival rate with both breasts preserved (64.2%) compared with BCS plus RT (56.0%) or initial mastectomy (0%). Of the breast-conserving strategies at 20 years, the breast event-free survival rate (no invasive cancer or DCIS) was greater for BCS plus RT (47.2%) compared with BCS alone (28.4%). Using just survival as the primary end point, mastectomy is the optimal strategy by a small margin. However, if quality-adjusted survival is at issue, mastectomy is the choice only if the yearly reduction in quality of life due to mastectomy is less than 1%. Conclusion: BCS with or without radiation compared with mastectomy as initial management of DCIS of the breast trades a slight decrease in survival rates for the value of breast preservation. This model should aid clinicians in matching treatments to their patients' preferences.

Original languageEnglish (US)
Pages (from-to)70-77
Number of pages8
JournalJournal of Clinical Oncology
Volume14
Issue number1
StatePublished - Jan 1996
Externally publishedYes

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Carcinoma, Intraductal, Noninfiltrating
Segmental Mastectomy
Mastectomy
Breast
Survival
Survival Rate
Radiation
Therapeutics
Disease-Free Survival
Breast Neoplasms
Radiation Dosage
Decision Support Techniques
Patient Preference
Quality of Life

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Trade-offs between survival and breast preservation for three initial treatments of ductal carcinoma-in-situ of the breast. / Hillner, B. E.; Desch, C. E.; Carlson, R. W.; Smith, Thomas J; Esserman, L.; Bear, H. D.

In: Journal of Clinical Oncology, Vol. 14, No. 1, 01.1996, p. 70-77.

Research output: Contribution to journalArticle

Hillner, B. E. ; Desch, C. E. ; Carlson, R. W. ; Smith, Thomas J ; Esserman, L. ; Bear, H. D. / Trade-offs between survival and breast preservation for three initial treatments of ductal carcinoma-in-situ of the breast. In: Journal of Clinical Oncology. 1996 ; Vol. 14, No. 1. pp. 70-77.
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abstract = "Purpose: To assess the trade-offs between survival and breast preservation of currently accepted approaches for ductal carcinoma-in-situ (DCIS) of the breast. Patients and Methods: Decision analysis was performed using the Markov model of hypothetical cohorts of 55-year-old white women with nonpalpable mammographic abnormalities found to be DCIS. Strategies were breast-conserving surgery (BCS), BCS with 50-Gy radiation (RT) or initial mastectomy. Recurrence rates were derived from the published literature. Main outcomes were overall, breast cancer-free, and event-free survival plus years of both breasts preserved. Results: Using the conditions defined in this model, the actuarial survival rates at 10 and 20 years were 91.7{\%} and 74.1{\%} for the initial mastectomy strategy, 91.0{\%} and 72.1{\%} for BCS plus RT, and 89.6{\%} and 68.2{\%} for BCS alone. At 20 years, the initial mastectomy strategy also had a greater breast cancer-free survival rate of 74.5{\%}, compared with 63.3{\%} for BCS plus RT, or 46.8{\%} for BCS alone. However, BCS alone had the highest survival rate with both breasts preserved (64.2{\%}) compared with BCS plus RT (56.0{\%}) or initial mastectomy (0{\%}). Of the breast-conserving strategies at 20 years, the breast event-free survival rate (no invasive cancer or DCIS) was greater for BCS plus RT (47.2{\%}) compared with BCS alone (28.4{\%}). Using just survival as the primary end point, mastectomy is the optimal strategy by a small margin. However, if quality-adjusted survival is at issue, mastectomy is the choice only if the yearly reduction in quality of life due to mastectomy is less than 1{\%}. Conclusion: BCS with or without radiation compared with mastectomy as initial management of DCIS of the breast trades a slight decrease in survival rates for the value of breast preservation. This model should aid clinicians in matching treatments to their patients' preferences.",
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T1 - Trade-offs between survival and breast preservation for three initial treatments of ductal carcinoma-in-situ of the breast

AU - Hillner, B. E.

AU - Desch, C. E.

AU - Carlson, R. W.

AU - Smith, Thomas J

AU - Esserman, L.

AU - Bear, H. D.

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N2 - Purpose: To assess the trade-offs between survival and breast preservation of currently accepted approaches for ductal carcinoma-in-situ (DCIS) of the breast. Patients and Methods: Decision analysis was performed using the Markov model of hypothetical cohorts of 55-year-old white women with nonpalpable mammographic abnormalities found to be DCIS. Strategies were breast-conserving surgery (BCS), BCS with 50-Gy radiation (RT) or initial mastectomy. Recurrence rates were derived from the published literature. Main outcomes were overall, breast cancer-free, and event-free survival plus years of both breasts preserved. Results: Using the conditions defined in this model, the actuarial survival rates at 10 and 20 years were 91.7% and 74.1% for the initial mastectomy strategy, 91.0% and 72.1% for BCS plus RT, and 89.6% and 68.2% for BCS alone. At 20 years, the initial mastectomy strategy also had a greater breast cancer-free survival rate of 74.5%, compared with 63.3% for BCS plus RT, or 46.8% for BCS alone. However, BCS alone had the highest survival rate with both breasts preserved (64.2%) compared with BCS plus RT (56.0%) or initial mastectomy (0%). Of the breast-conserving strategies at 20 years, the breast event-free survival rate (no invasive cancer or DCIS) was greater for BCS plus RT (47.2%) compared with BCS alone (28.4%). Using just survival as the primary end point, mastectomy is the optimal strategy by a small margin. However, if quality-adjusted survival is at issue, mastectomy is the choice only if the yearly reduction in quality of life due to mastectomy is less than 1%. Conclusion: BCS with or without radiation compared with mastectomy as initial management of DCIS of the breast trades a slight decrease in survival rates for the value of breast preservation. This model should aid clinicians in matching treatments to their patients' preferences.

AB - Purpose: To assess the trade-offs between survival and breast preservation of currently accepted approaches for ductal carcinoma-in-situ (DCIS) of the breast. Patients and Methods: Decision analysis was performed using the Markov model of hypothetical cohorts of 55-year-old white women with nonpalpable mammographic abnormalities found to be DCIS. Strategies were breast-conserving surgery (BCS), BCS with 50-Gy radiation (RT) or initial mastectomy. Recurrence rates were derived from the published literature. Main outcomes were overall, breast cancer-free, and event-free survival plus years of both breasts preserved. Results: Using the conditions defined in this model, the actuarial survival rates at 10 and 20 years were 91.7% and 74.1% for the initial mastectomy strategy, 91.0% and 72.1% for BCS plus RT, and 89.6% and 68.2% for BCS alone. At 20 years, the initial mastectomy strategy also had a greater breast cancer-free survival rate of 74.5%, compared with 63.3% for BCS plus RT, or 46.8% for BCS alone. However, BCS alone had the highest survival rate with both breasts preserved (64.2%) compared with BCS plus RT (56.0%) or initial mastectomy (0%). Of the breast-conserving strategies at 20 years, the breast event-free survival rate (no invasive cancer or DCIS) was greater for BCS plus RT (47.2%) compared with BCS alone (28.4%). Using just survival as the primary end point, mastectomy is the optimal strategy by a small margin. However, if quality-adjusted survival is at issue, mastectomy is the choice only if the yearly reduction in quality of life due to mastectomy is less than 1%. Conclusion: BCS with or without radiation compared with mastectomy as initial management of DCIS of the breast trades a slight decrease in survival rates for the value of breast preservation. This model should aid clinicians in matching treatments to their patients' preferences.

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