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Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case–Control Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Various patient, treatment, and pathologic factors have been associated with an increased risk of local recurrence (LR) following breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS). However, the strength and importance of individual factors has varied; whether combining factors improves prediction, particularly in community practice, is uncertain. In a large, population-based cohort of women with DCIS treated with BCT in three community-based practices, we assessed the validity of the Memorial Sloan-Kettering Cancer Center (MSKCC) DCIS nomogram, which combines clinical, pathologic, and treatment features to predict LR.

Methods

We reviewed slides of patients with unilateral DCIS treated with BCT. Regression methods were used to estimate risks of LR. The MSKCC DCIS nomogram was applied to the study population to compare the nomogram-predicted and observed LR at 5 and 10 years.

Results

The 495 patients in our study were grouped into quartiles and octiles to compare observed and nomogram-predicted LR. The 5-year absolute risk of recurrence for lowest and highest quartiles was 4.8 and 33.1 % (95 % CI 3.1–6.4 and 24.2–40.9, respectively; p < 0.0001). The overall correlation between 10-year nomogram-predicted recurrences and observed recurrences was 0.95. Compared with observed 10-year LR rates, the risk estimates provided by the nomogram showed good correlation, and reasonable discrimination with a c-statistic of 0.68.

Conclusions

The MSKCC DCIS nomogram provided good prediction of the 5- and 10-year LR when applied to a population of patients with DCIS treated with BCT in a community-based practice. This nomogram, therefore, is a useful treatment decision aid for patients with DCIS.

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Acknowledgment

Supported by Public Health Service Grants U19 CA 79689 and R01 CA81302. This study was conducted under the auspices of the HMO Cancer Research Network (CRN), a consortium of 14 integrated health care delivery systems with more than 11 million enrollees nationwide: (1) Fallon Community Health Plan, Meyers Primary Care Institute; (2) Geisinger Health System; (3) Group Health; (4) Harvard Pilgrim Health Care Institute and Harvard Medical School; (5) HealthPartners; (6) Henry Ford Hospital and Health System; (7) Kaiser Permanente Colorado; (8) Kaiser Permanente Georgia; (9) Kaiser Permanente Hawaii; (10) Kaiser Permanente Northern California; (11) Kaiser Permanente Northwest; (12) Kaiser Permanente Southern California; (13) Lovelace Health System; and (14) Marshfield Clinic (U19 CA079689 Ed Wagner). The authors thank Zaineb Sharafali for her assistance with data collection.

Disclosure

The authors have no disclosures to report.

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Authors and Affiliations

  1. Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Laura C. Collins MD & Stuart J. Schnitt MD

  2. Harvard Medical School, Boston, MA, USA

    Laura C. Collins MD, Larissa Nekhlyudov MD, Stuart J. Schnitt MD & Suzanne W. Fletcher MD

  3. Kaiser Permanente, Northern CA, Oakland, CA, USA

    Ninah Achacoso MS, Charles P. Quesenberry Jr. PhD & Laurel A. Habel PhD

  4. Kaiser Permanente, Southern CA, Pasadena, CA, USA

    Reina Haque PhD, MPH

  5. Harvard Vanguard Medical Associates, Boston, MA, USA

    Larissa Nekhlyudov MD

  6. Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Larissa Nekhlyudov MD & Suzanne W. Fletcher MD

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  1. Laura C. Collins MD
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  2. Ninah Achacoso MS
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  3. Reina Haque PhD, MPH
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  4. Larissa Nekhlyudov MD
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  6. Stuart J. Schnitt MD
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  7. Laurel A. Habel PhD
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  8. Suzanne W. Fletcher MD
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Correspondence to Laura C. Collins MD.

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Collins, L.C., Achacoso, N., Haque, R. et al. Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case–Control Study. Ann Surg Oncol 22 (Suppl 3), 502–508 (2015). https://doi.org/10.1245/s10434-015-4641-x

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  • DOI: https://doi.org/10.1245/s10434-015-4641-x

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