{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:48:50Z","timestamp":1793134130520,"version":"4.5.0"},"reference-count":37,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2025,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the risk of subsequent ipsilateral invasive breast cancer in women who do not receive upfront surgery on diagnosis of ductal carcinoma in situ (DCIS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cohort study using data abstracted directly from patients\u2019 medical records and from a national cancer registry in patients with primary DCIS diagnosed between 2008 and 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Commission on Cancer accredited facilities (n=1330) in the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1780 women with diagnosis of primary DCIS on needle biopsy who were alive and free of invasive breast cancer at 6 months after diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>No surgery within 6 months of diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary outcome: ipsilateral invasive breast cancer; secondary outcome: death due to breast cancer. Subgroup analysis by risk status, based on eligibility criteria of ongoing active monitoring trials: low risk if aged \u226540 years at diagnosis of an imaging detected, nuclear grade I\/II, and hormone receptor positive DCIS; high risk otherwise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age at diagnosis was 63 years, and median follow-up was 53.3 months. Among all 1780 women, the number of ipsilateral invasive breast cancer events was 115 (6.5%) and the number of deaths from breast cancer was 29 (1.6%). The 8 year cumulative incidence of ipsilateral invasive breast cancer was 10.7% (95% confidence interval (CI) 8.4% to 12.8%). Incidence of invasive cancer differed by both disease and patient related factors, with 8 year cumulative incidences of ipsilateral invasive breast cancer ranging from 8.5% (95% CI 4.7% to 12.1%) among women at low risk (n=650) to 13.9% (10.5% to 17.2%) among those at high risk (n=833). The 8 year disease specific survival probability was 96.4% (95% CI 95.0% to 97.9%) overall and 98.1% (96.7% to 99.6%) among women at low risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a cohort of patients who did not receive initial surgery for DCIS, the 8 year cumulative incidence of invasive cancer in the same breast varied between 8% and 14%. Effective risk stratification tools and shared decision making are essential for this patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2024-083542","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T07:35:16Z","timestamp":1751960116000},"page":"e083542","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Cancer outcomes in women without upfront surgery for ductal carcinoma in situ: observational cohort study"],"prefix":"10.1136","volume":"390","author":[{"given":"Marc D","family":"Ryser","sequence":"first","affiliation":[{"name":"Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA"},{"name":"Department of Mathematics, Duke University, Durham NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha M","family":"Thomas","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute 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