Breast
Natalia Polidorio, MD, PhD
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, New York, United States
Natalia Polidorio, MD, PhD
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, New York, United States
V. Morgan Jones, MD
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
Varadan Sevilimedu, DrPH
Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center, United States
.jpg "Monica Morrow, MD photo")
Monica Morrow, MD
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Kimberly J. Van Zee, MS, MD
Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
Andrea V. Barrio, MD
Associate Attending/Dept. of Surgery/Breast Service
Memorial Sloan Kettering Cancer Center
New York, New York, United States
We identified women with DCIS treated with BCS at a single institution from 1978-2016. Patients were grouped by self-reported race and ethnicity as Asian, Black, Hispanic, and White. Clinicopathologic features were compared across groups, and the association of race/ethnicity on recurrence was analyzed using Kaplan–Meier, competing risk, and multivariable analysis (MVA).
Results:
Of 4207 cases, 261 (6%) were Asian, 358 (9%) were Black, 226 (5%) were Hispanic, and 3362 (80%) were White. Median age was 57 years (IQR 49, 67), 56% received radiotherapy (RT), and 26% received endocrine therapy. Black women were older and Asian women were younger (median age: 60 vs 53, p < 0.001). Black women more often had clinical presentation (p = 0.006), and Black and Hispanic women more often had ≥ 3 excisions (p = 0.006). RT receipt was most common among Hispanic women (p = 0.02). At a median follow-up of 8.8 years, 602 (14%) had local recurrence (LR) (315 [52%] DCIS; 284 [47%] invasive; 3 [ < 1%] unknown). The 10-year LR rate was 15%, with lower LR in those treated with RT (11%) than without (20%, p < 0.001), despite RT patients having more high-risk characteristics. LR rates varied significantly by race/ethnicity, with a higher 10-year rate in Black women (25%) compared with Asian (11%), Hispanic (15%) and White (14%) women (p = 0.03). This statistically significant difference persisted in the no-RT cohort (10-year rate: 31% [Black], 13% [Asian], 25% [Hispanic], 19% [White], p = 0.043), but not in the RT cohort (21% [Black], 9% [Asian], 9% [Hispanic] and 11% [White], p = 0.3). Using competing risk analysis, the risk of invasive recurrence was similar or lower than DCIS recurrence in each racial group with or without RT. On MVA, after adjusting for other factors, a higher LR risk persisted among Black women (hazard ratio [HR] 1.48, 95% CI 1.12-1.95, p = 0.01). Older age, radiologic presentation, margins ≥ 2 mm, endocrine therapy, and RT were associated with lower LR rates (Table).
Conclusions:
Black women with DCIS had significantly higher LR rates after BCS than Asian, Hispanic, and White women, even after adjusting for clinicopathologic risk factors. These higher rates of LR should be considered when making adjuvant therapy decisions.