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A Comparison of Tumor Biology in Primary Ductal Carcinoma In Situ Recurring as Invasive Carcinoma versus a New In Situ

DOI: 10.1155/2013/582134

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Introduction. About half of all new ipsilateral events after a primary ductal carcinoma in situ (DCIS) are invasive carcinoma. We studied tumor markers in the primary DCIS in relation to type of event (invasive versus in situ). Methods. Two hundred and sixty-six women with a primary DCIS from two source populations, all with a known ipsilateral event, were included. All new events were regarded as recurrences. Patient and primary tumor characteristics (estrogen receptor (ER), progesterone receptor (PR), HER2, EGFR, and Ki67) were evaluated. Logistic regression was used to calculate odd ratios and 95% confidence intervals in univariate and multivariate analyses. Results. One hundred and thirty-six of the recurrences were invasive carcinoma and 130 were in situ. The recurrence was more often invasive if the primary DCIS was ER+ (OR 2.5, 95% CI 1.2–5.1). Primary DCIS being HER2+ (OR 0.5, 95% CI 0.3–0.9), EGFR+ (OR 0.4, 95% CI 0.2–0.9), and ER95?/HER2+ (OR 0.2, 95% CI 0.1–0.6) had a lower risk of a recurrence being invasive. Conclusions. In this study, comparing type of recurrence after a DCIS showed that the ER?/HER2+ tumors were related to a recurrence being a new DCIS. And surprisingly, tumors being ER+, HER2?, and EGFR? were related to a recurrence being invasive cancer. 1. Introduction Ductal carcinoma in situ (DCIS) of the breast is a clinically and molecularly heterogeneous disease with different malignant potentials [1, 2]. The risk of local recurrence after breast-conserving surgery only (BCS) is rather high and even higher than after surgery for invasive breast cancer [3, 4]. In DCIS, adding radiotherapy after BCS lowered the relative risk with approximately 50%, from 28.1% to 12.9% after ten years in a meta-analyses including four randomized studies [5, 6]. About half of the women with a local recurrence develop a new DCIS and the other half an invasive carcinoma [7–10]. Although women with a primary DCIS have a very good prognosis [6], those with a subsequent invasive carcinoma have an increased risk of dying from breast cancer. In a recently published study the 15-year breast cancer specific survival was just over 60% among those with an invasive recurrence after a primary DCIS [11, 12]. One of the major goals of the treatment of DCIS is to prevent invasive disease. There are surgical and biological risk factors for local recurrence, for example, young age, mode of detection (clinically detected as compared to screening detected), margins, and grade [13, 14]. Also, a recently published study using the Oncotype DX DCIS score showed that

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