The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: a systematic review

Abstract

Objective

The ma­jor­ity of ‘low-risk’ (grade I/​II) Duc­tal Car­ci­noma In Situ (DCIS) may not progress to in­va­sive breast can­cer dur­ing a wom­en's life­time. There­fore, the safety of ac­tive sur­veil­lance ver­sus stan­dard sur­gi­cal treat­ment for DCIS is prospec­tively be­ing eval­u­ated in clin­i­cal tri­als. If proven safe and se­lec­tively im­ple­mented in clin­i­cal prac­tice, a sig­nif­i­cant group of women with low-risk DCIS may forego surgery and ra­dio­ther­apy in the fu­ture. Iden­ti­fi­ca­tion of mod­i­fi­able and non-mod­i­fi­able risk fac­tors as­so­ci­ated with prog­no­sis af­ter a pri­mary DCIS would also en­hance our care of women with low-risk DCIS.

Methods To iden­tify mod­i­fi­able and non-mod­i­fi­able risk fac­tors for sub­se­quent breast events af­ter DCIS, we per­formed a sys­tem­atic lit­er­a­ture search in PUBMED, EM­BASE and Sco­pus. Results Six out of the 3870 ar­ti­cles re­trieved were in­cluded for fi­nal data ex­trac­tion. These six stud­ies in­cluded a to­tal of 4950 pa­tients with pri­mary DCIS and 640 recorded sub­se­quent breast events. There was mod­er­ate ev­i­dence for an as­so­ci­a­tion of a fam­ily his­tory of breast can­cer, pre­menopausal sta­tus, high BMI, and high breast den­sity with a sub­se­quent breast can­cer or fur­ther DCIS. Conclusion There is a lim­ited num­ber of re­cent stud­ies pub­lished on the im­pact of mod­i­fi­able and non-mod­i­fi­able risk fac­tors on sub­se­quent events af­ter DCIS. The avail­able ev­i­dence is in­suf­fi­cient to iden­tify po­ten­tial tar­gets for risk re­duc­tion strate­gies, re­flect­ing the rel­a­tively small num­bers and the lack of long-term fol­low-up in DCIS, a low-event con­di­tion.