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Patients were enrolled in cohort 1: low- or intermediate-grade DCIS, size\u2009\u2264\u20092.5\u2009cm (<jats:italic>n<\/jats:italic>\u2009=\u2009561); or cohort 2: high-grade DCIS, size\u2009\u2264\u20091\u2009cm (<jats:italic>n<\/jats:italic>\u2009=\u2009104). The Kaplan\u2013Meier method was used to estimate time-to-event distributions. Cox proportional hazard methods were used to estimate hazard ratios (HRs) and tests for significance for event times. 561 patients were enrolled in cohort 1 and 104 in cohort 2. After central pathology review, 26% in cohort 1 were recategorized as high-grade and 26% in cohort 2 as low- or intermediate-grade. Mean DCIS size was similar at 7.5\u2009mm in cohort 1 and 7.8\u2009mm in cohort 2. Surgical margin was \u22653\u2009mm in 96% of patients, and about 30% received tamoxifen. Median follow-up was 19.2 years. There were 104 IBEs, of which 54 (52%) were invasive. The IBE and invasive IBE rates increased in both cohorts up to 15 years, then plateaued. The 20-year IBE rates were 17.8% for cohort 1 and 28.7% for cohort 2 (<jats:italic>p<\/jats:italic>\u2009=\u20090.005), respectively. Invasive IBE occurred in 9.8% and 15.1% (<jats:italic>p<\/jats:italic>\u2009=\u20090.09), respectively. On multivariable analysis, IBE risk increased with size and was higher in cohort 2, but grade and margin width were not significantly associated with IBE. For patients with DCIS treated with excision without radiation, the rate of IBE increased with size and assigned cohort mostly in the first 15 years.<\/jats:p>","DOI":"10.1038\/s41523-024-00622-w","type":"journal-article","created":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T03:02:31Z","timestamp":1708743751000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Lumpectomy without radiation for ductal carcinoma in situ of the breast: 20-year results from the ECOG-ACRIN E5194 study"],"prefix":"10.1038","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-6544","authenticated-orcid":false,"given":"Jean L.","family":"Wright","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Gray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habib","family":"Rahbar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher E.","family":"Comstock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judy A.","family":"Tjoe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8861-9980","authenticated-orcid":false,"given":"Sunil","family":"Badve","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abram","family":"Recht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9031-2010","authenticated-orcid":false,"given":"Joseph A.","family":"Sparano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E.","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-1063","authenticated-orcid":false,"given":"Antonio C.","family":"Wolff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,2,24]]},"reference":[{"key":"622_CR1","first-page":"1","volume":"26","author":"CJ Allegra","year":"2009","unstructured":"Allegra, C. 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Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J. Clin. Oncol. 33, 3938\u20133944 (2015).","journal-title":"J. Clin. Oncol."},{"key":"622_CR7","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1093\/jnci\/djt067","volume":"105","author":"LJ Solin","year":"2013","unstructured":"Solin, L. J. et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J. Natl Cancer Inst. 105, 701\u2013710 (2013).","journal-title":"J. Natl Cancer Inst."},{"key":"622_CR8","doi-asserted-by":"publisher","first-page":"5974","DOI":"10.1245\/s10434-021-09903-1","volume":"28","author":"C Shah","year":"2021","unstructured":"Shah, C. et al. The clinical utility of DCISionRT\u00ae on radiation therapy decision making in patients with ductal carcinoma in situ following breast-conserving surgery. Ann. Surg. Oncol. 28, 5974\u20135984 (2021).","journal-title":"Ann. Surg. 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Diagnostic Histopathology of the Breast (Churchill Livingstone, 1987)."}],"container-title":["npj Breast Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41523-024-00622-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41523-024-00622-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41523-024-00622-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T03:02:52Z","timestamp":1708743772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41523-024-00622-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,24]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["622"],"URL":"https:\/\/doi.org\/10.1038\/s41523-024-00622-w","relation":{},"ISSN":["2374-4677"],"issn-type":[{"value":"2374-4677","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,24]]},"assertion":[{"value":"5 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"16"}}