Biology, treatment, and outcome in very young and older women with DCIS

Background. This study examines a modern cohort of women with ductal carcinoma-in-situ (DCIS) in order to identify potential differences in clinical presentation, treatments, and outcome based on age. Methods. From 1996 to 2009, a total of 2037 patients with pure DCIS were treated. Clinical presentation, pathologic factors, type of surgery and adjuvant therapy, and local recurrence rates among age groups were compared and analyzed. Median follow-up was 5.2 years. Results. There were 132 patients (6.5 %) aged<40, 1,690 (83 %) aged 40-70, and 215 (10.5 %) aged>70. Younger patients (<40) were significantly more likely to have a family history of breast cancer, present with clinical symptoms, undergo mastectomy with immediate reconstruction, and have a contralateral prophylactic mastectomy (P<0.05). Older patients (>70) were significantly less likely to use adjuvant radiotherapy and tamoxifen (P<0.05). No significant differences were found in DCIS size, estrogen receptor status, necrosis, or contralateral breast cancer based on age. Among women<40, 29.3 % had evidence of multicentric disease versus 17.7 and 13.3 % in the women aged 40-70 and those>70, respectively (P = 0.004). On multivariate analysis, younger age (<40), larger-size DCIS (≥1.5 cm), and no use of radiotherapy were significant independent predictors of locoregional recurrence. The 5 year rates of local recurrence were 10.1 % in women<40 compared with 3.2 % in older women (P = 0.005). Conclusions. Younger patients with DCIS more often have multicentric disease, present with clinical findings, and opt for or require mastectomy with immediate reconstruction. Conservative surgery is only appropriate for younger patients if adjuvant radiotherapy is delivered.