Study sheds light on risks of breast cancer after pre-invasive disease

Women who are diagnosed with ductal carcinoma in situ (DCIS) during breast screening go on to experience higher risks of developing breast cancer and of death from breast cancer, compared with the general population, according to new research published by The BMJ today. The risks were more than double those of the general population, even for women diagnosed with low or intermediate grade DCIS, and lasted until at least 20 years after diagnosis.

DCIS is a disease where malignant breast cells are found but have not spread beyond the milk ducts.

Diagnoses of DCIS have increased substantially in recent years, especially among women attending breast screening programmes. DCIS isn’t immediately life-threatening and does usually have a good prognosis, but it can increase the risk of developing an invasive breast cancer later on. The extent of this extra risk is uncertain.

So, researchers at the Nuffield Department of Population Health and Public Health England set out to evaluate the long term risks of invasive breast cancer and of death from breast cancer after DCIS diagnosed through breast screening.

Their findings are based on data from 35,024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014. They compared rates of invasive breast cancer and of death from breast cancer with the corresponding national rates for women of the same age in the same calendar year.

The researchers found that by December 2014, 2,076 women had developed invasive breast cancer, an incidence rate of 8.82 per 1,000 per year and more than double the number expected from national rates. In the same group of women, 310 died from breast cancer, a death rate of 1.26 per 1,000 per year and 70% more than expected from national rates.

For both invasive breast cancer and death from breast cancer, the increases continued for at least two decades.

The results also suggest that women who had more intensive treatment, such as a mastectomy, had a lower long term risk of invasive breast cancer than those who had breast conserving surgery, even when radiotherapy was given.

Professor Sarah Darby from the Nuffield Department of Population Health, who led the research, said ‘This is the first time we have been able to show that women with DCIS have more than double the risk of developing invasive breast cancer and dying from the disease, even up to 20 years after being diagnosed.

‘While this is concerning, understanding more about this risk puts us in a better position to make informed decisions about how to treat and monitor women with DCIS to give them the best possible care and save lives.’

The researchers point out that, at the moment, surveillance of women after a diagnosis of DCIS focuses just on the first few years. In the UK, for example, most women are recalled for yearly surveillance mammograms for five years, after which further follow-up is every three years via the national screening programme up to age 70 years.

Further studies are needed to build on these findings, in particular to try to work out which type of DCIS is most closely linked to the development of invasive breast cancer. This may have implications for follow-up and the frequency of surveillance imaging.

Funding was provided by Cancer Research UK, the National Institute for Health Research Oxford Biomedical Research Centre, and the UK Medical Research Council.

Oxford joins cancer coronavirus registry project

Oncologists at the University of Oxford have joined with researchers at the University of Leeds and Birmingham to help monitor cancer patients who have tested positive for COVID-19.

The purpose of the UK Coronavirus Cancer Monitoring scheme is to assess how cancer patients will be impacted by the coronavirus outbreak and help to make informed treatment pathways through clinician-lead reports. In doing so, it is hoped that the monitoring system will ensure that high-quality cancer care is being delivered in order to safeguard patients during this time.

There are many unknowns in terms of the interactions between COVID-19 and cancer, including disease-specific mortality such as which type of cancer patients are at risk, age-specific cancer mortality such as how older cancer patients will cope with coronavirus infection, interaction with cancer treatments and who is most at risk in terms of treatment, impact of public health interventions and potential impact on patients.

Oxford will contribute to the project by collecting information to submit to a database, which tracks the prevalence of COVID-19 infections with associated anonymised data about the site of disease and mortality. This will be achieved through a newly-formed network of cancer COVID-19 response reporting clinicians, covering 82% of the UK’s cancer centre network.

In return, the scheme will relay daily updates back to the Oxford cancer centres and help to inform key decisions for patients who are at-risk.

The project team is made up of medical oncologists, data scientists and graphic designers including the University of Oxford, University of Birmingham, University of Leeds, Kings College London, The Clatterbridge Cancer Centre, University College London and Edinburgh Cancer Hospital. This work is supported by the Oxford Biomedical Research Centre.

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