kwh experience dr. carmen ho. breast cancer as most common cancer in women in hong kong dcis as...
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![Page 1: KWH Experience Dr. Carmen Ho. Breast cancer as most common cancer in women in Hong Kong DCIS as precursor of invasive cancer Heterogeneous group](https://reader030.vdocuments.mx/reader030/viewer/2022032605/56649e7e5503460f94b81f8f/html5/thumbnails/1.jpg)
KWH Experience
Dr. Carmen Ho
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Breast cancer as most common cancer in women in Hong Kong
DCIS as precursor of invasive cancer Heterogeneous group with diverse malignant
potential
Incidence of DCIS increased with mammographic screening 3/100,000 to 34/100,000 in 50-69 years old
Steenbergen. Breast Cancer Res Treat.2009.
Best treatment for DCIS remains a controversy
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Mastectomy vs. breast conserving treatment + RTRT reduces local recurrence rate
(13.4% vs. 3.9%)NSABP B-17
Similar local recurrence and survivalNSABP B-04
Acceptance of BCT in Chinese (survey)29-49%
Chua et al. Breast J. 2005
BCT rate in HK for breast cancer : 22-30%
Yau et al. Int J Radiat Oncol Biol Phys. 2008
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Retrospective study Period : January 2002 – April 2009 Inclusion
Patients diagnosed with DCIS after surgical excision Patients with micro- or invasive features were not
included 212 patients included
Age : 57.2 (37.8 – 87.5)
Median FU : 31.0 months (0.3 - 81.4 months)
Bilateral disease : 22 7 with bilateral disease on presentation
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Table 1: Patient Characteristics
Presentation
Mammographic abnormality 130 (62%)
Breast lump 58 (27%)
Nipple discharge 17 (8%)
Nipple abnormality 3 (1%)
Mastalgia 4 (2%)
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Average size : 2.02cm (0.1 – 7 cm)
SizeScreen detected group : 1.32cmSymptomatic group : 2.47cm
(P<0.01)
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Operation
Mastectomy 80
Mastectomy with immediate reconstruction 28
Breast conserving treatment 104
Wide local excision 27
ROLL 31
Wire guided excision 42
Microdochectomy 4
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BCT offered to 175 patients
Unicentric tumor <3cm Appropriate tumor to breast ratioAcceptance of adjuvant radiotherapy
104 patients accepted BCT (59.4%)
75% were screen detected
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96.2% (100/104) have adjuvant RT
4 patients with small foci (<0.6cm) and low grade DCIS
1 has IBTR 5 years later as DCIS
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32 patients (31.7%) receiving BCT have close margin (<3mm)5 patients underwent re-excision8 required subsequent mastectomy Boost dose of radiotherapy All free of local recurrence
Sentinel LN biopsy was done in 98 patientsPositive sentinel LN noted in 3 patientsAxillary dissection was performed
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198 / 212 (93.4%) remained disease free
Screen detected : 95.4% (124/130)
Symptomatic : 90.2% (74/82)
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4 patients with BCT have ipsilateral breast tumor recurrence (3.8%)
3 recurred as invasive ductal carcinoma, subsequent mastectomy performed
1 recurred as DCIS with ROLL done
All remained disease free after salvage treatment
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1 patient diedPresented with blood stained nipple
dischargeMicrodochectomy performed : DCIS with
involved margin Simple mastectomy performed
DCIS (high grade with comedo necrosis) 6 months after mastectomy, developed
bone metastasis
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Emphasize on importance of screening mammogram
Acceptance of BCT + RT as treatment 75% patients receiving BCT were screen detected
69% with clear margin (>3mm)
Positive sentinel LN in 3.0% patients with DCIS
Risk of local recurrence after BCT 3.8% with median FU 31.0 months
Success of salvage treatment after IBTR
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