Outcomes of Active Surveillance for Ductal Carcinoma in Situ: A Computational Risk Analysis.

Ryser, Marc D; Worni, Mathias; Turner, Elizabeth L; Marks, Jeffrey R; Durrett, Rick; Hwang, E Shelley (2016). Outcomes of Active Surveillance for Ductal Carcinoma in Situ: A Computational Risk Analysis. Journal of the National Cancer Institute JNCI, 108(5) Oxford University Press 10.1093/jnci/djv372

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BACKGROUND Ductal carcinoma in situ (DCIS) is a noninvasive breast lesion with uncertain risk for invasive progression. Usual care (UC) for DCIS consists of treatment upon diagnosis, thus potentially overtreating patients with low propensity for progression. One strategy to reduce overtreatment is active surveillance (AS), whereby DCIS is treated only upon detection of invasive disease. Our goal was to perform a quantitative evaluation of outcomes following an AS strategy for DCIS. METHODS Age-stratified, 10-year disease-specific cumulative mortality (DSCM) for AS was calculated using a computational risk projection model based upon published estimates for natural history parameters, and Surveillance, Epidemiology, and End Results data for outcomes. AS projections were compared with the DSCM for patients who received UC. To quantify the propagation of parameter uncertainty, a 95% projection range (PR) was computed, and sensitivity analyses were performed. RESULTS Under the assumption that AS cannot outperform UC, the projected median differences in 10-year DSCM between AS and UC when diagnosed at ages 40, 55, and 70 years were 2.6% (PR = 1.4%-5.1%), 1.5% (PR = 0.5%-3.5%), and 0.6% (PR = 0.0%-2.4), respectively. Corresponding median numbers of patients needed to treat to avert one breast cancer death were 38.3 (PR = 19.7-69.9), 67.3 (PR = 28.7-211.4), and 157.2 (PR = 41.1-3872.8), respectively. Sensitivity analyses showed that the parameter with greatest impact on DSCM was the probability of understaging invasive cancer at diagnosis. CONCLUSION AS could be a viable management strategy for carefully selected DCIS patients, particularly among older age groups and those with substantial competing mortality risks. The effectiveness of AS could be markedly improved by reducing the rate of understaging.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Worni, Mathias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0198-0157

Publisher:

Oxford University Press

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

08 Apr 2016 07:54

Last Modified:

18 Oct 2018 13:12

Publisher DOI:

10.1093/jnci/djv372

PubMed ID:

26683405

BORIS DOI:

10.7892/boris.77518

URI:

https://boris.unibe.ch/id/eprint/77518

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