Evidence map›Paper›PMID 40628457›Full record

Observational studyBMJ (Clinical research ed.)2025

Cancer outcomes in women without upfront surgery for ductal carcinoma in situ: observational cohort study.

Marc D Ryser, Samantha M Thomas, Yan Li, Thomas Lynch, Anne Barber, Amanda B Francescatti, Deborah Collyar, Danalyn Byng, Lars J Grimm, Ann H Partridge and 3 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ (Clinical research ed.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Marc D RyserDepartment of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
Samantha M ThomasDuke Cancer Institute Biostatistics Shared Resource, Duke University, Durham NC, USA.
Yan LiDuke Cancer Institute Biostatistics Shared Resource, Duke University, Durham NC, USA.
Thomas LynchDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Anne BarberCancer Programs, American College of Surgeons, Chicago, IL, USA.
Amanda B FrancescattiCancer Programs, American College of Surgeons, Chicago, IL, USA.
Deborah CollyarPatient author, Danville, CA, USA.
Danalyn ByngDivision of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
Lars J GrimmDepartment of Radiology, Duke University Medical Center, Durham, NC, USA.
Ann H PartridgeDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Alastair M ThompsonDepartment of Surgery, Baylor College of Medicine, Houston, TX, USA.
Terry HyslopDivision of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA.
E Shelley HwangDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.ORCID 0000-0002-8571-1148

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo 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).

designObservational cohort study using data abstracted directly from patients' medical records and from a national cancer registry in patients with primary DCIS diagnosed between 2008 and 2015.

settingCommission on Cancer accredited facilities (n=1330) in the US.

participants1780 women with diagnosis of primary DCIS on needle biopsy who were alive and free of invasive breast cancer at 6 months after diagnosis.

interventionsNo surgery within 6 months of diagnosis.

main outcome measuresPrimary 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 ≥40 years at diagnosis of an imaging detected, nuclear grade I/II, and hormone receptor positive DCIS; high risk otherwise.

resultsMedian 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.

conclusionsIn 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.

Indexed as

Breast NeoplasmsCarcinoma, Intraductal, NoninfiltratingAdultAgedCohort StudiesFemaleHumansMiddle AgedUnited States

Identifiers

PMID40628457
PMCPMC12235502

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.