The influence of young age and positive family history of breast cancer onthe prognosis of ductal carcinoma in situ treated by excision with or without radiation therapy or by mastectomy

Background: Several recent studies have investigated the influence of famil y history on the progression of DCIS patients treated by tylectomy and radi ation therapy. Since three treatment strategies hare been used for DCIS at our institution, we evaluated the influence of family history and young age on outcome by treatment method. Methods: Between 1/1/83 and 12/31/92, 128 patients were treated for DCIS by mastectomy (n = 50, 39%), tylectomy alone (n = 43, 34%), and tylectomy wit h radiation therapy (n = 35, 27%). Median follow-up is 8.7 years, Thirty-ni ne patients had a positive family history of breast cancer; 26 in a mother, sister, or daughter (first-degree relative); and 26 in a grandmother, aunt , or cousin (second-degree relative). Thirteen patients had a positive fami ly history in both first- and second-degree relatives. Results: Six women de developed a recurrence in the treated breast; all of these were initially treated with tylectomy alone. There were no recurrence s in the mastectomy group or the tylectomy patients treated with postoperat ive radiation therapy. Patients with a positive family history had a 10.3% local recurrence rate (LRR), vs. a 2.3% LRR in patients with a negative fam ily history (p = 0.05), Four of 44 patients (9.1%) 50 years of age or young er recurred, compared to two of 84 patients (2.1%) over the age of 50 (p = 0.10). Fifteen patients had both a positive family history and mere 50 year s of age or younger. Among these women, the recurrence rate was 20%. Women in this group treated by lesionectomy alone had a LRR of 38% (3 of 8). Conclusion: The most important determinant of outcome was the selection of treatment modality, with all of the recurrences occurring in the tylectomy alone group. In addition to treatment method, a positive family history sig nificantly influenced LRR in patients treated by tylectomy, especially in w omen 50 years of age or younger. These results suggest that DCIS patients, particularly premenopausal women with a positive family history, benefit fr om treatment of the entire breast, and raise concerns about treating patien ts with a possible genetic susceptibility to breast cancer with tylectomy a lone. (C) 2000 Elsevier Science Inc.