OUTCOME AFTER INVASIVE LOCAL RECURRENCE IN PATIENTS WITH DUCTAL CARCINOMA IN-SITU OF THE BREAST

Purpose: To detail the outcome, in terms of local recurrence, local in vasive recurrence, distant recurrence, and breast cancer mortality for patients previously treated for ductal carcinoma in situ (DCIS). Pati ents and Methods: Clinical, pathologic, and outcome data were collecte d prospectively for 707 patients with DCIS accrued from 1972 through J une 1997. Results: There were 74 local recurrences; 39 were noninvasiv e (DCIS) and 35 were invasive, Fifty-one percent of patients with inva sive recurrences presented with stage 1 disease; the remainder present ed with more advanced disease, Invasive local recurrence after mastect omy was a rare event that occurred in 0.8% of patients. Invasive recur rence after breast preservation was more common and occurred in 7.4% o f patients. The 8-year probability of breast cancer mortality after br east preservation was 2.1%, a number that is likely to increase with l onger follow-up. The 8-year breast cancer-specific mortality and dista nt-disease probability for the subgroup of 74 patients with locally re current disease was 8.8% and 20.8%, respectively, If only the 35 invas ive recurrences are considered as events, the 8-year breast cancer-spe cific mortality and distant disease probability was 14.4% and 27.1%, r espectively. Conclusion: Invasive local recurrence after breast preser vation treatment for patients with DCIS is a serious event that conver ts patients with previous stage 0 disease to patients with disease tha t ranges from stage I to stage IV, These results, however, indicate th at most DCIS patients with local recurrence can be salvaged. (C) 1998 by American Society of Clinical Oncology.