What is the life expectancy of patients with triple negative Ductal Carcinoma In Situ (DCIS)?

From the Guidelines

The life expectancy for patients with triple negative Ductal Carcinoma In Situ (DCIS) is generally excellent, with 10-year survival rates exceeding 95%. Triple negative DCIS has a slightly higher risk of recurrence compared to hormone receptor-positive DCIS, but since DCIS is a non-invasive cancer confined to the milk ducts, it is highly treatable. Standard treatment typically involves surgical removal through lumpectomy with radiation or mastectomy, depending on the extent of disease. Unlike invasive triple negative breast cancer, DCIS doesn't require chemotherapy in most cases. However, patients should understand that triple negative DCIS lacks receptors for estrogen, progesterone, and HER2, meaning hormone therapies like tamoxifen aren't effective for recurrence prevention. Regular follow-up is essential, with clinical breast exams every 6-12 months and annual mammography. The main concern with triple negative DCIS is the approximately 10-15% risk of recurrence over 10 years, with about half of recurrences being invasive cancer. This risk is why proper initial treatment and vigilant monitoring are crucial for maintaining the excellent life expectancy associated with DCIS, as supported by recent guidelines 1.

Some key points to consider in the management of triple negative DCIS include:

• The use of whole-breast radiation therapy (WBRT) after breast-conserving surgery (BCS) to reduce the risk of local recurrence, without impacting survival 1.
• The consideration of omitting radiation in patients with low-risk DCIS, defined as tumor size <10 mm, low or intermediate nuclear grade, and adequate surgical margins 1.
• The importance of adequate surgical margins to minimize the risk of local recurrence, with margins >10 mm considered adequate and margins <1 mm considered inadequate 1.
• The role of regular follow-up, including clinical breast exams and annual mammography, to monitor for recurrence and ensure timely intervention if necessary.

Overall, the management of triple negative DCIS requires a multidisciplinary approach, taking into account the individual patient's risk factors, tumor characteristics, and personal preferences, with the goal of optimizing outcomes and minimizing the risk of recurrence, as supported by the most recent and highest quality evidence 1.

From the Research

Life Expectancy of Triple Negative DCIS

• The life expectancy of patients with triple negative Ductal Carcinoma In Situ (DCIS) is not directly addressed in the provided studies.
• However, study 2 compares the clinicopathological characteristics and prognosis of patients with invasive ductal carcinoma coexisting with DCIS (IDC-DCIS) and invasive ductal carcinoma (IDC) in triple-negative breast cancer (TNBC).
• The study found that the disease-free survival (DFS) of the IDC-DCIS group was better than that of the IDC group, but the overall survival (OS) of the two groups was not statistically significant.
• The 5-year DFS was 87.9% for the IDC-DCIS group and 82.6% for the IDC group, while the 5-year OS was 96.2% for the IDC-DCIS group and 96.0% for the IDC group.
• Study 3 found that treatment with lumpectomy and radiotherapy was associated with a significant reduction in breast cancer mortality compared with either lumpectomy alone or mastectomy alone in patients with DCIS.

Factors Affecting Life Expectancy

• Study 2 identified the coexistence of DCIS, lymph node pathologic stage, tumor location, and adjuvant chemotherapy as independent prognostic factors for DFS in TNBC.
• Study 4 found that high-nuclear-grade DCIS lesions and detection of the initial DCIS lesion by palpation were associated with recurrence as invasive cancer, while high-nuclear-grade lesions, resection margins that were positive, uncertain, or less than 10 mm disease-free, and age 40-49 years at diagnosis were associated with recurrence as DCIS.

Treatment and Survival

• Study 5 found that breast conservation therapy with radiation therapy (RT) is a viable treatment option for women with DCIS, with a 5-year actuarial breast recurrence-free rate of 95%.
• Study 6 reported a 10-year relapse-free survival rate of 97% in patients with DCIS treated with mastectomy, with only 0.9% of patients developing a local-regional recurrence.
• Study 3 found that the actuarial 15-year breast cancer mortality rate was 2.33% for patients treated with lumpectomy alone, 1.74% for patients treated with lumpectomy and radiation, and 2.26% for patients treated with mastectomy.