Age-specific survival after breast conservation versus mastectomy for ductal carcinoma in situ of the breast
In brief
Mastectomy linked to nearly twice the mortality in women 70+ with DCIS
In this Swedish cohort, women aged 70 and older with ductal carcinoma in situ who had mastectomy without radiation had nearly twice the overall mortality of those treated with breast-conserving surgery and radiation. Breast conservation with radiation was also linked to lower mortality overall, but the difference was not consistent across analyses and could reflect treatment-selection differences; 10-year local recurrence was 7.2%.
- Journal
- Breast cancer research and treatment (Q1)
- Published
- 20 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Jana de Boniface, Robert Szulkin, Per Karlsson, Anna L V Johansson
- PMID
- 42902063
- DOI
- 10.1007/s10549-026-08097-y
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 23 October 2026): Direct comparison of breast conservation, mastectomy, radiotherapy, and recurrence
Abstract
PURPOSE: Breast conservation for invasive breast cancer is associated with better survival and fewer complications than mastectomy, which is especially relevant for older patients. It is unclear whether this can be extrapolated to ductal carcinoma in situ (DCIS). METHODS: This population-based cohort study used data from the Breast Cancer Database Sweden (BCBaSe 3.0) to compare overall survival (OS), breast cancer-specific survival (BCSS) and local recurrence (LR) probabilities in three different age groups (< 60, 60-69, 70 + years) of women with primary DCIS undergoing breast-conserving surgery with radiotherapy (BCS + RT), mastectomy without radiotherapy (Mx-RT), or breast-conserving surgery without radiotherapy (BCS-RT) during 2008-2019. Complete cases (CC) and multiple imputation (MI) analyses were applied. RESULTS: In 7165 women, treatment was BCS + RT (53.3%), BCS-RT (13.4%), or Mx-RT (33.2%). Estimated 10-year OS was 90.4% (95% CI 89.3-91.5) and BCSS 98.8% (98.3-99.2). After adjustments for patient and tumour factors, including socioeconomic status and comorbidity, Mx-RT was associated with a higher overall mortality than BCS + RT in CC (HR 2.10; 95% CI 1.20-3.67) but not in MI analyses (HR 1.29; 0.95-1.76). In age 70 + years, however, the overall mortality was consistently increased (CC: HR 2.48; 1.09-5.62, MI: HR 1.89; 1.23-2.90). Also BCS-RT was associated with a higher overall mortality than BCS + RT (CC: HR 2.68; 1.34-5.34, and MI: HR 1.72; 1.23-2.39). The 10-year LR probability was low (7.2%, 95% CI 6.3-8.0). Compared to BCS + RT, Mx-RT was associated with a lower (HR 0.18, 95% CI 0.11-0.28) and BCS-RT with a higher LR risk (HR 1.79; 1.31-2.46), especially among ages 70+. CONCLUSION: BCS + RT in DCIS appears safe. Acknowledging potential selection bias, BCS + RT may be associated with favourable overall survival outcomes in older women despite a higher risk of local recurrence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.