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Ductal carcinoma in situ carries a higher risk of death than previously thought, new study finds

Women diagnosed with ductal carcinoma in situ (DCIS) are twice as likely to die from breast cancer compared to the general U.S. population, according to a new study led by Dr. Steven Narod.

August 20, 2015  |  Download Release

Women diagnosed with ductal carcinoma in situ (DCIS) are twice as likely to die from breast cancer compared to the general U.S. population, according to a new study led by Dr. Steven Narod.

“Our work shows that DCIS has more in common with small invasive cancers than previously thought,” explains Dr. Narod, a scientist with Women’s College Research Institute and a professor with the Dalla Lana School of Public Health at the University of Toronto. “In these cases, we’ve found that there’s an inherent potential for DCIS to spread to other organs.”

In this sense, DCIS is, in fact, an early form of breast cancer. 

“This paper effectively redefines our understanding of the early stages of breast cancer and shows that the cancerous behavior is present very early on,” adds Dr. Narod. “There is a potential for chemotherapy to reduce the rates of death from DCIS but for most women the mortality rate (less than two per cent) is too low to justify toxic therapy.”

The research paper, which was published today in JAMA Oncology, also describes how radiotherapy and mastectomy prevented recurrence but did not diminish breast cancer mortality rates.

In the current study, the researchers looked at data from over 100,000 American women who had been diagnosed with DCIS (a type of stage 0 breast cancer).  From the data, the researchers found that:

  • About 1.1 per cent of women died of breast cancer within 10 years of being diagnosed with DCIS.
  • About 3.3 per cent of women died of breast cancer within 20 years of being diagnosed with DCIS.
  • Women diagnosed with DCIS before age 35 were 17 times more likely to die from breast cancer within 10 years, compared to women in the general U.S. population.
  • Black women had a higher risk of dying from breast cancer within 20 years of being diagnosed with DCIS, compared to white women.
  • Women with DCIS who subsequently developed an invasive form of cancer in the same breast were 18.1 times more likely to die of breast cancer.
  • The majority of women with DCIS (54.1 per cent) who died of breast cancer did not have an invasive in-breast recurrence of cancer, prior to death.

About DCIS:  Approximately 600,000 women in the United States and 60,000 women in Canada are living with a history of DCIS  – some have been told that this is an early cancer and others have been told that this is a precancerous condition. Women under age 40 and black women have the highest chance of dying of DCIS.

DCIS accounts for approximately 20 per cent of breast cancers detected through mammography. Some women with DCIS experience a second breast cancer event – and a small proportion ultimately die of breast cancer. Until now, the impact of various factors (including age at diagnosis, ethnicity and treatment) on mortality rates has not been studied.

Breast Cancer Mortality after a Diagnosis of Ductal Carcinoma in situ (DCIS)
Steven A Narod, Javaid Iqbal, Vasily Giannakeas, Victoria Sopik

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For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.

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