Hashmi Junaid Zia, Khattak Muhammad Ali, Ghafoor Ammarah, Abdulrasheed Habeeb, Abbasy Jibran, Malik Adnan, Malik Amman
Breast Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Cureus. 2025 May 14;17(5):e84076. doi: 10.7759/cureus.84076. eCollection 2025 May.
Introduction Breast cancer is the most common type of cancer in women worldwide, and early detection plays a key role in improving survival and treatment outcomes. National breast screening programs help identify both invasive and non-invasive cancers, such as ductal carcinoma in situ (DCIS). This study aimed to compare the one-year outcomes of screen-detected invasive breast cancer and DCIS in women diagnosed through a regional screening program. Methods A retrospective cohort study was conducted at our tertiary center in the UK. Patients diagnosed with screen-detected breast cancers from January 1, 2023, to December 31, 2024, were followed for one year post-surgery. A total of 216 patients were included: 108 with invasive breast cancer (Group A) and 108 with DCIS (Group B). Data on demographics, tumor characteristics, surgical procedures, postoperative complications, and oncological outcomes were collected using electronic records. Comparative statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, USA). Chi-square and independent t-tests were used for categorical and continuous variables, and odds ratios (ORs) with 95% confidence intervals were calculated to assess the strength of associations. Statistical significance was set at p < 0.05. Results The mean age was similar between groups (Group A: 57.6 ± 10.8 years; Group B: 58.1 ± 11.5 years). Estrogen and progesterone receptor (ER/PR) positivity was high in both groups (70.4% vs. 75%, = 0.431). Human epidermal growth factor receptor 2 (HER2) positivity was more frequent in Group A (17.6% vs 11.1%, = 0.173). Multifocality (24.1% vs 13%, = 0.038), positive margins (17.6% vs 6.5%, = 0.015), and nodal involvement (23.1% vs 0%, < 0.001) were significantly more common in invasive cancers. Postoperative complications (hematoma, wound infection, seroma, flap necrosis) were similar in both groups. However, local recurrence was higher in Group A (9.3% vs 2.8%, = 0.044), and one-year disease-free survival was lower (85.2% vs 97.2%, = 0.002). Chemotherapy was given only to patients in Group A (59.3%). Conclusion In our study, we found that screen-detected in situ breast cancer had better short-term outcomes than invasive cancer, with fewer recurrences and higher one-year disease-free survival. Both groups were similar in demographics, but invasive cancer had more multifocality and required more aggressive surgery. Re-excision was more common in the in situ group. The results suggest avoiding overtreatment of DCIS and using risk tools to balance treatment with quality of life. Improving patient education, collaboration, and standardizing surgical decisions is important. The study highlights the need for evidence-based approaches in treatment planning.
引言
乳腺癌是全球女性中最常见的癌症类型,早期检测对提高生存率和治疗效果起着关键作用。国家乳腺癌筛查项目有助于识别浸润性和非浸润性癌症,如导管原位癌(DCIS)。本研究旨在比较通过区域筛查项目诊断出的女性中,筛查发现的浸润性乳腺癌和DCIS的一年期结局。
方法
在英国我们的三级中心进行了一项回顾性队列研究。对2023年1月1日至2024年12月31日期间诊断为筛查发现的乳腺癌患者进行术后一年的随访。共纳入216例患者:108例浸润性乳腺癌患者(A组)和108例DCIS患者(B组)。使用电子记录收集人口统计学、肿瘤特征、手术程序、术后并发症和肿瘤学结局的数据。使用SPSS 26版(美国IBM公司,阿蒙克)进行比较统计分析。卡方检验和独立t检验用于分类变量和连续变量,并计算95%置信区间的比值比(OR)以评估关联强度。统计学显著性设定为p < 0.05。
结果
两组的平均年龄相似(A组:57.6 ± 10.8岁;B组:58.1 ± 11.5岁)。两组的雌激素和孕激素受体(ER/PR)阳性率均较高(70.4%对75%,p = 0.431)。人表皮生长因子受体2(HER2)阳性在A组更常见(17.6%对11.1%,p = 0.173)。多灶性(24.1%对13%,p = 0.038)、切缘阳性(17.6%对6.5%,p = 0.015)和淋巴结受累(23.1%对0%,p < 0.001)在浸润性癌症中明显更常见。两组的术后并发症(血肿、伤口感染、血清肿、皮瓣坏死)相似。然而,A组的局部复发率较高(9.3%对2.8%,p = 0.044),一年无病生存率较低(85.2%对97.2%,p = 0.002)。仅对A组患者进行化疗(59.3%)。
结论
在我们的研究中,我们发现筛查发现的原位乳腺癌比浸润性癌具有更好的短期结局,复发较少且一年无病生存率更高。两组在人口统计学方面相似,但浸润性癌多灶性更多,需要更积极的手术。原位组再次切除更常见。结果表明应避免对DCIS进行过度治疗,并使用风险工具来平衡治疗与生活质量。改善患者教育、协作和规范手术决策很重要。该研究强调了在治疗规划中采用循证方法的必要性。