Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial
Jack Cuzick,Ivana Sestak,Sarah E Pinder,Ian O. Ellis,Sharon Forsyth,Nigel J Bundred,John F. Forbes,H Bishop,Ian S. Fentiman,W.D. George +9 more
TLDR
This updated analysis confirms the long-term beneficial effect of radiotherapy and reports a benefit for tamoxifen in reducing local and contralateral new breast events for women with DCIS treated by complete local excision.Abstract:
Summary Background Initial results of the UK/ANZ DCIS (UK, Australia, and New Zealand ductal carcinoma in situ) trial suggested that radiotherapy reduced new breast events of ipsilateral invasive and ductal carcinoma in situ (DCIS) compared with no radiotherapy, but no significant effects were noted with tamoxifen. Here, we report long-term results of this trial. Methods Women with completely locally excised DCIS were recruited into a randomised 2×2 factorial trial of radiotherapy, tamoxifen, or both. Randomisation was independently done for each of the two treatments (radiotherapy and tamoxifen), stratified by screening assessment centre, and blocked in groups of four. The recommended dose for radiation was 50 Gy in 25 fractions over 5 weeks (2 Gy per day on weekdays), and tamoxifen was prescribed at a dose of 20 mg daily for 5 years. Elective decision to withhold or provide one of the treatments was permitted. The endpoints of primary interest were invasive ipsilateral new breast events for the radiotherapy comparison and any new breast event, including contralateral disease and DCIS, for tamoxifen. Analysis of each of the two treatment comparisons was restricted to patients who were randomly assigned to that treatment. Analyses were by intention to treat. All trial drugs have been completed and this study is in long-term follow-up. This study is registered, number ISRCTN99513870. Findings Between May, 1990, and August, 1998, 1701 women were randomly assigned to radiotherapy and tamoxifen, radiotherapy alone, tamoxifen alone, or to no adjuvant treatment. Seven patients had protocol violations and thus 1694 patients were available for analysis. After a median follow-up of 12·7 years (IQR 10·9–14·7), 376 (163 invasive [122 ipsilateral vs 39 contralateral], 197 DCIS [174 ipsilateral vs 17 contralateral], and 16 of unknown invasiveness or laterality) breast cancers were diagnosed. Radiotherapy reduced the incidence of all new breast events (hazard ratio [HR] 0·41, 95% CI 0·30–0·56; p Interpretation This updated analysis confirms the long-term beneficial effect of radiotherapy and reports a benefit for tamoxifen in reducing local and contralateral new breast events for women with DCIS treated by complete local excision. Funding Cancer Research UK and the Australian National Health and Medical Research Council.read more
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Endometrial cancer risk in postmenopausal breast cancer patients treated with tamoxifen or aromatase inhibitors.
Ivana Sestak,Jack Cuzick +1 more
TL;DR: Evidence for an increase in endometrial cancers with tamoxifen in breast cancer treated patients is now very clear and there is an important need for further studies to clearly determine the influence of aromatase inhibitors on the endometrium in tamoxIFen-naïve women.
Journal ArticleDOI
Narrowing down the focus: what are the main predictive markers for ductal carcinoma in situ?
Julia Ys Tsang,Gary Mk Tse +1 more
TL;DR: Optimal management ofuctal carcinoma in situ should be based on the tumor characteristics and tailored to the risk of subsequent recurrence and invasive events, probably owing to the lack of standardized methods for assessment.
Journal ArticleDOI
New Treatment Paradigms for Patients with Ductal Carcinoma In Situ
TL;DR: One of the most poorly understood clinical diagnoses in breast cancer is ductal carcinoma in situ (DCIS), which now accounts for almost one third of all mammographically detected malignancies as discussed by the authors.
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The Japanese Breast Cancer Society clinical practice guideline for radiotherapy of breast cancer.
Kenji Sekiguchi,Yasuhiro Ogawa,Naoko Sanuki,Satoko Arahira,Etsuyo Ogo,Michio Yoshimura,Chikako Yamauchi,Masahiko Oguchi,Shozo Ohsumi,Hirofumi Mukai +9 more
TL;DR: It is confirmed that postoperative radiotherapy significantly improved patient survival rates in seven randomized controlled trials from different parts of the world.
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The Senologic International Society Survey on Ductal Carcinoma <i>In Situ</i>: Present and Future
TL;DR: The Senologic International Society network members participated to an online survey using a questionnaire, between November 2021 and February 2022 as discussed by the authors , to investigate the management of ductal carcinoma in situ (DCIS) in different countries; identify both consensual practices and controversial topics; and survey opinions about the future management of DCIS.
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Lumpectomy Compared with Lumpectomy and Radiation Therapy for the Treatment of Intraductal Breast Cancer
Bernard Fisher,Joseph P. Costantino,Carol K. Redmond,Edwin R. Fisher,Richard G. Margolese,Nikolay V. Dimitrov,Norman Wolmark,Wickerham Dl,Melvin Deutsch,L Ore +9 more
TL;DR: Breast irradiation after lumpectomy is more appropriate than Lumpectomy alone for women with localized ductal carcinoma in situ, and five-year event-free survival was better in the women who received breast irradiation.
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Bernard Fisher,James J. Dignam,Norman Wolmark,Eleftherios P. Mamounas,Joseph P. Costantino,W. Poller,Edwin R. Fisher,D L Wickerham,Melvin Deutsch,Richard G. Margolese,Nikolay V. Dimitrov,Maureen T. Kavanah +11 more
TL;DR: Through 8 years of follow-up, findings continue to indicate that lumpectomy plus radiation is more beneficial than Lumpectomy alone for women with localized, mammographically detected DCIS.