Probability of Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ

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Our ductal carcinoma in situ (DCIS) nomogram is a tool designed to estimate the likelihood that a patient will develop invasive cancer or recurrent DCIS in the same breast over the 5 years and 10 years after undergoing breast-conserving surgery for DCIS. Recurrence is the return of a cancer -- in this case, as either DCIS or as invasive cancer -- after a period during which it could not be detected. Risk of recurrence is a key factor in treatment planning. In consultation with a physician, patients can use their results from this nomogram to make decisions regarding various treatment options, such as radiation therapy and anti-estrogen therapy.

Results produced by this tool are based on data from patients treated at MSK, a large research institution with surgeons who perform a high volume of breast cancer procedures. All results must be understood in the context of each patient’s specific treatment plan. Patients and caregivers using this tool should discuss the result with the patient’s physician.

To gather the information required to use this nomogram, use our worksheet.

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All fields are required unless noted optional
years (25 to 90)
Do you have any first-degree (mother, sister, or daughter) or second-degree (aunt, niece, or grandmother) relatives with breast cancer?
Was the abnormality found during a physical examination (“Clinical”) or detected only by a breast imaging procedure such as a mammogram (“Radiologic”)?
Did you or will you receive any radiation after the breast-conserving surgery to remove the cancer?
Did you or will you receive anti-estrogen treatment (e.g., tamoxifen, raloxifene, anastrozole, letrozole, or exemestane) after the breast-conserving surgery?
What was the nuclear grade of the cancer cells?
What is nuclear grade?
Nuclear grade as defined on the pathology report refers to how much variation there is in the size and shape of the nuclei of the cells.
Was necrosis detected along with cancer?
What is necrosis?
The pathology report will say whether necrosis was present. Necrosis is dead tumor cell debris found with the DCIS.
Were your surgical margins negative or positive/close? (For this nomogram, a negative margin is defined as a width of >2mm; a positive/close margin is defined as 2mm or less.)
About surgical margins
The surgical margin refers to the distance between tumor tissue and the outermost edge of the surrounding tissue that was removed along with it. After tumor tissue is removed during surgery, a pathologist examines the tissue under a microscope to see whether the borders of the tissue removed are free of cancer cells.
How many surgical excisions were necessary to remove the cancer?
In what year was your surgery performed?
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Supporting Publications

Probability of Recurrence After Breast-Conserving Surgery for DCIS

Probability that cancer will return in the same breast originally treated with breast-conserving surgery for DCIS

Source publication listed first, followed by selected external validation studies

Rudloff U, Jacks LM, Goldberg JI, Wynveen CA, Brogi E, Patil S, Van Zee KJ. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010 Aug 10;28(23):3762-9. doi: 10.1200/JCO.2009.26.8847. Epub 2010 Jul 12. PMID: 20625132.

Sweldens C, Peeters S, van Limbergen E, Janssen H, Laenen A, Patil S, Van Zee KJ, Weltens C. Local relapse after breast-conserving therapy for ductal carcinoma in situ: a European single-center experience and external validation of the Memorial Sloan-Kettering Cancer Center DCIS nomogram. Cancer J. 2014 Jan-Feb;20(1):1-7. doi: 10.1097/PPO.0000000000000025. PMID: 24445756.

Wang F, Li H, Tan PH, Chua ET, Yeo RM, Lim FL, Kim SW, Tan DY, Wong FY. Validation of a nomogram in the prediction of local recurrence risks after conserving surgery for Asian women with ductal carcinoma in situ of the breast. Clin Oncol (R Coll Radiol). 2014 Nov;26(11):684-91. doi: 10.1016/j.clon.2014.08.004. Epub 2014 Sep 4. PMID: 25194727.

Collins LC, Achacoso N, Haque R, Nekhlyudov L, Quesenberry CP Jr, Schnitt SJ, Habel LA, Fletcher SW. Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case-Control Study. Ann Surg Oncol. 2015 Dec;22 Suppl 3:S502-8. doi: 10.1245/s10434-015-4641-x. Epub 2015 Jun 10. PMID: 26059650.