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Open Access Research article

Long-term survival of women with basal-like ductal carcinoma in situ of the breast: a population-based cohort study

Wenjing Zhou1*, Karin Jirström2, Christine Johansson3, Rose-Marie Amini3, Carl Blomqvist4, Olorunsola Agbaje5 and Fredrik Wärnberg1

Author Affiliations

1 Department of Surgical Science, Uppsala University, Uppsala, SE-75105, Sweden

2 Department of Laboratory Medicine, Lund University, Lund, Sweden

3 Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden

4 Department of Oncology, Helsinki University Central Hospital, Finland

5 School of Medicine, Division of Cancer Studies, King's College, London, UK

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BMC Cancer 2010, 10:653  doi:10.1186/1471-2407-10-653

Published: 30 November 2010

Abstract

Background

Microarray gene-profiling of invasive breast cancer has identified different subtypes including luminal A, luminal B, HER2-overexpressing and basal-like groups. Basal-like invasive breast cancer is associated with a worse prognosis. However, the prognosis of basal-like ductal carcinoma in situ (DCIS) is still unknown. Our aim was to study the prognosis of basal-like DCIS in a large population-based cohort.

Methods

All 458 women with a primary DCIS diagnosed between 1986 and 2004, in Uppland and Västmanland, Sweden were included. TMA blocks were constructed. To classify the DCIS tumors, we used immunohistochemical (IHC) markers (estrogen-, progesterone-, HER2, cytokeratin 5/6 and epidermal growth factor receptor) as a surrogate for the gene expression profiling. The association with prognosis was examined for basal-like DCIS and other subtypes using Kaplan-Meier survival analyses and Cox proportional hazards regression models.

Results

IHC data were complete for 392 women. Thirty-two were basal-like (8.2%), 351 were luminal or HER2-positive (89.5%) and 9 unclassified (2.3%). Seventy-six women had a local recurrence of which 34 were invasive. Another 3 women had general metastases as first event. Basal-like DCIS showed a higher risk of local recurrence and invasive recurrence 1.8 (Confidence interval (CI) 95%, 0.8-4.2) and 1.9 (0.7-5.1), respectively. However, the difference was not statistically significant. Also, no statistically significant increased risk was seen for triple-negative or high grade DCIS.

Conclusions

Basal-like DCIS showed about a doubled, however not statistically significant risk for local recurrence and developing invasive cancer compared with the other molecular subtypes. Molecular subtyping was a better prognostic parameter than histopathological grade.