June 1997

National Treatment Trends for Ductal Carcinoma In Situ of the Breast

Author Affiliations

From the Department of Surgery, Evanston Hospital, Evanston, Ill (Drs D. J. Winchester and D. P. Winchester), and the Department of Surgery, Northwestern University Medical School (Drs D. J. Winchester and D. P. Winchester) and the Cancer Department of the American College of Surgeons (Mr Menck and Dr D. P. Winchester), Chicago, Ill. The National Cancer Data Base is a joint project of the commission on cancer of the American College of Surgeons and the American Cancer Society.

Arch Surg. 1997;132(6):660-665. doi:10.1001/archsurg.1997.01430300102020

Objective:  To evaluate the national treatment trends for the management of ductal carcinoma in situ as related to the individual characteristics of patients and to the reporting of demographics.

Design:  National Cancer Data Base review.

Patients:  Patients (N=39 010) who were diagnosed as having ductal carcinoma in situ between 1985 and 1993.

Main Outcome Measures:  Treatment principles, including the use of breast-preserving surgery, axillary lymph node dissection, and radiotherapy, as related to the following variables: age, income level, and ethnicity of the patient; the tumor size, grade, and anatomical subsite; year of diagnosis; geographic location of treatment; and hospital type and caseload.

Results:  During the 8 years of analysis, the use of breast preservation therapy increased from 31% to 54%. Treatment selection varied to some degree with each of the variables examined. Tumors with favorable sizes and grades were associated with increased rates of breast preservation and lower rates of axillary lymph node dissection and radiotherapy utilization. Overall, only 45% of the patients who were treated with breast preservation received adjuvant radiotherapy. However, during this study, radiotherapy utilization increased from 38% to 54%. Axillary lymph node dissection was performed in 49% of the patients with a 12% reduction in use over time.

Conclusions:  Breast-preserving surgery now accounts for more than half of all cases of ductal carcinoma in situ followed by the National Cancer Data Base. However, there still remains an inappropriately high rate of axillary lymph node dissection and a low rate of radiotherapy utilization. Clinical trial results and professional education should continue to optimize the management of patients with ductal carcinoma in situ.Arch Surg. 1997;132:660-665