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Nashimoto M, Asano Y, Matsui H, Machida Y, Hoshi K, Kurosumi M, Fukuma E. Comparison of locoregional recurrence risk among nipple-sparing mastectomy, skin-sparing mastectomy, and simple mastectomy in patients with ductal carcinoma in situ: a single-center study. Breast Cancer 2024:10.1007/s12282-024-01613-2. [PMID: 39017823 DOI: 10.1007/s12282-024-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND In invasive breast cancer, there are no differences among the mid- and long-term oncological safety results of nipple-sparing mastectomy (NSM), skin-sparing mastectomy (SSM), and simple mastectomy (SM). There are several reports comparing NSM and SSM with SM in the context of ductal carcinoma in situ (DCIS); however, the eligibility criteria vary among institutions, and there are no reports that compare all three surgical methods simultaneously within the same institution. This study aimed to compare the local recurrence and survival rates of the three techniques (NSM, SSM, and SM) in Japanese patients undergoing mastectomy for DCIS. METHODS Patients undergoing NSM, SSM, or SM at our institution between 2006 and 2015 were identified, and their outcomes were analyzed. RESULTS The mean follow-up period was 80.4 months (standard deviation [SD]: 37.1 months). NSM was performed in 152 cases, SSM in 49, and SM in 44. Five of 245 patients developed local recurrences. Four of these patients had invasive cancer. The primary endpoints of 5-year cumulative local recurrence were 2.4% (95% confidence interval [CI]: 0.0-5.0) for NSM, 2.2% (95% CI: 0.0-6.3) for SSM, and 0% (95% CI: 0.0-0.0) for SM. There were no significant differences among the 5-year local recurrence rates. CONCLUSIONS In this single-center, retrospective study, the oncological safety of SSM and NSM for DCIS was comparable to that of conventional SM.
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Affiliation(s)
- Mika Nashimoto
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
| | - Yuko Asano
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Clinical Research Support Office, Kameda Medical Center, Chiba, Japan
| | - Youichi Machida
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
- Department of Radiology, Kameda Medical Center, Chiba, Japan
| | - Kazuei Hoshi
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Masafumi Kurosumi
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
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Mokbel K, Alamoodi M. Reassessing treatment strategies for DCIS: analysis of survival and recurrence patterns. Breast Cancer Res Treat 2024; 205:423-424. [PMID: 38361145 DOI: 10.1007/s10549-024-07268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Kefah Mokbel
- Princess Grace Hospital, The London Breast Institute, London, W1U 5NY, UK
| | - Munaser Alamoodi
- Princess Grace Hospital, The London Breast Institute, London, W1U 5NY, UK.
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Nguyen DL, Greenwood HI, Rahbar H, Grimm LJ. Evolving Treatment Paradigms for Low-Risk Ductal Carcinoma In Situ: Imaging Needs. AJR Am J Roentgenol 2024; 222:e2330503. [PMID: 38090808 DOI: 10.2214/ajr.23.30503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.
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Affiliation(s)
- Derek L Nguyen
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
| | - Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Lars J Grimm
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
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Mokbel K. Unlocking the Power of the Homing Phenomenon: Why Breast Conserving Surgery Outshines Mastectomy in Overall Survival. Clin Breast Cancer 2024; 24:85-92. [PMID: 37925361 DOI: 10.1016/j.clbc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Breast cancer stands as the most frequently diagnosed malignancy in women, holding a prominent position among the leading causes of cancer-related fatalities on a global scale. Despite significant advances in treatment modalities, approximately 20% of patients experience relapses after the first 5 years of postdiagnosis surveillance. While initial investigations from the 1970s indicated comparable survival rates between breast-conserving surgery (BCS) coupled with radiation therapy and mastectomy, recent research suggests that, within the context of modern systemic and radiation therapy, BCS followed by radiation may offer an improved overall survival benefit. Nevertheless, extended follow-up studies have unveiled a notable increase in the risk of locoregional recurrence associated with breast conserving therapy in contrast to mastectomy. This article introduces a novel hypothesis rooted in the biological phenomenon of homing to elucidate this intriguing clinical observation. We postulate that a breast homing mechanism of reactivated circulating and disseminated tumor cells mediated by chemotaxis involving at least the CXCR4-SDF-1 axis may provide a biological rationale for this clinical phenomenon.
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Affiliation(s)
- Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, W1U 5NY, UK.
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5
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Kim R, Kawai A, Wakisaka M, Shimoyama M, Yasuda N, Ito M, Kin T, Arihiro K. Outcomes in patients with non‐invasive breast carcinoma. Cancer Rep (Hoboken) 2022; 6:e1768. [PMID: 36494178 PMCID: PMC10075290 DOI: 10.1002/cnr2.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM Non-invasive breast carcinoma is considered to be localized disease and is distinguished from invasive ductal and lobular carcinomas. The local recurrence of non-invasive carcinoma after surgery may lead to development of invasive carcinoma and promote distant metastasis, which worsens the prognosis for breast cancer mortality. The distant metastasis of non-invasive carcinoma may involve the ductal microvasculature without invasion. The outcomes of non-invasive breast carcinoma were examined in this retrospective cohort study. METHODS AND RESULTS Of 872 primary breast cancers diagnosed at a single center between May 2008 and March 2022, 93 (10.6%) were found to be non-invasive carcinomas and were examined in this study. The breast cancer recurrence and survival rates of patients with non-invasive carcinoma were analyzed retrospectively. The median follow-up period was 1891 (range, 5-4804) days. All patients underwent surgical treatment [mastectomy with sentinel lymph node biopsy (SLNB) and partial mastectomy with or without SLNB, tumorectomy, and microdochectomy]. Postoperatively, radiation therapy was administered to 73 (78.4%) of the patients and endocrine therapy was administered to 64 (81.0%) of 79 patients with hormone-receptor positivity. Of 26 patients who underwent partial mastectomy with SLNB, 24 (92.3%) showed isolated tumor cells in the SLNs on one-step nucleic acid amplification. Local recurrence was observed in three (0.3%) patients; no distant metastasis was observed. One patient died of a noncancerous disease. The overall survival rate was 98.0% and the breast cancer-specific survival rate was 100.0%. CONCLUSIONS Non-invasive breast carcinoma, like invasive breast carcinoma, causes local recurrence, but has a good prognosis without distant metastasis. The clinical significance of isolated tumor cells in the SLNs as a systemic component of non-invasive breast carcinoma remains to be elucidated.
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Affiliation(s)
- Ryungsa Kim
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Ami Kawai
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Megumi Wakisaka
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Mika Shimoyama
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Naomi Yasuda
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Mitsuya Ito
- Department of Breast Surgery Hiroshima City Hospital Hiroshima Japan
| | - Takanori Kin
- Department of Breast Surgery Hiroshima City Hospital Hiroshima Japan
| | - Koji Arihiro
- Department of Anatomical Pathology Hiroshima University Hospital Hiroshima Japan
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Pandey M, Wen PX, Ning GM, Xing GJ, Wei LM, Kumar D, Mayuren J, Candasamy M, Gorain B, Jain N, Gupta G, Dua K. Intraductal delivery of nanocarriers for ductal carcinoma in situ treatment: a strategy to enhance localized delivery. Nanomedicine (Lond) 2022; 17:1871-1889. [PMID: 36695306 DOI: 10.2217/nnm-2022-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Ductal carcinoma in situ describes the most commonly occurring, noninvasive malignant breast disease, which could be the leading factor in invasive breast cancer. Despite remarkable advancements in treatment options, poor specificity, low bioavailability and dose-induced toxicity of chemotherapy are the main constraint. A unique characteristic of nanocarriers may overcome these problems. Moreover, the intraductal route of administration serves as an alternative approach. The direct nanodrug delivery into mammary ducts results in the accumulation of anticancer agents at targeted tissue for a prolonged period with high permeability, significantly decreasing the tumor size and improving the survival rate. This review focuses mainly on the intraductal delivery of nanocarriers in treating ductal carcinoma in situ, together with potential clinical translational research.
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Affiliation(s)
- Manisha Pandey
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia.,Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh, 123031, India
| | - Pung Xiau Wen
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Giam Mun Ning
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Gan Jia Xing
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Liu Man Wei
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Dinesh Kumar
- Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh, 123031, India
| | - Jayashree Mayuren
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Mayuren Candasamy
- Department of Life Sciences, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Bapi Gorain
- Department of Pharmaceutical Sciences & Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, Jaipur, 302017, India.,Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai, 602105, India.,Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, 248007, India
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia.,Faculty of Health, Australian Research Centre in Complementary & Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Swarnkar PK, Mokbel K. Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy. Breast Cancer Res Treat 2021; 187:919-920. [PMID: 33928460 DOI: 10.1007/s10549-021-06245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Parinita K Swarnkar
- GKT School of Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
| | - Kefah Mokbel
- London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Pl, Marylebone, London, W1U 5NY, UK
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