SSO 2024: De-escalation of Locoregional Therapy for Ductal Carcinoma in Situ

By: Bryna Goeking
Posted: Friday, April 5, 2024

Older adults diagnosed with ductal carcinoma in situ who have limited life expectancy have low rates of locoregional recurrence, yet many still receive high-intensity therapies such as radiation treatment and axillary surgery, according to Eliza Hersh Lorentzen, MD, of Brigham and Women’s Hospital/Harvard Medical School, Boston, and colleagues. “As the incidence of breast cancer rises in an aging U.S. population, clear consensus on opportunities for de-escalation of locoregional therapy in older patients with limited life expectancy is needed,” they noted in their study, which was presented at the 2024 Society of Surgical Oncology (SSO) Annual Meeting (Abstract 10).

The study focused on 5,346 women who were diagnosed with ductal carcinoma in situ (< 5 cm) between 2010 and 2015, and 927 (17.3%) had a life expectancy of up to 5 years. The median age of the patients was 75 (range, 70–97 years). Intensity of locoregional therapy was the primary outcome. The therapies included mastectomy plus axillary surgery, mastectomy alone, lumpectomy plus radiotherapy and axillary surgery, lumpectomy plus radiotherapy, lumpectomy alone, and no treatment.

Based on the findings of an unadjusted analysis, compared with patients who had a life expectancy of more than 5 years, more patients with a life expectancy of up to 5 years underwent lumpectomy alone (39.4% vs 27.0%, P < .001), mastectomy without axillary surgery (8.1% vs 5.3%, P <.001), or no treatment (5.8% vs 3.2%, P < .001). A total of 710 women (17.6%) underwent lumpectomy with axillary surgery. Although there was no significant difference in women undergoing lumpectomy and axillary surgery by life expectancy, fewer women with a lower life expectancy underwent lumpectomy plus axillary surgery and radiotherapy vs those with a higher life expectancy. After the investigators adjusted for a variety of variables, women with a life expectancy of up to 5 years had a significantly greater likelihood of undergoing lumpectomy alone than other treatments.

Disclosure: Dr. Hersh reported on conflicts of interest. No disclosure information was provided for the other study authors. 

2024 SSO Annual Meeting

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