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The management of ductal carcinoma in situ of the breast: a screened population-based analysis

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

A recent SEER study identified significant variations in the care of women with DCIS, yet several potential confounding variables were not included. We report a patterns of care study of women with DCIS to better understand the gap between evidence-based knowledge and the management of DCIS.

Methods

We studied all cases of DCIS diagnosed through the Ontario Breast Screening Program from 1991 to 2000. Data was obtained by database linkage and chart abstraction. A logistic regression model using generalized estimating equations to adjust for clustering was used.

Results

About 320,236 women were screened and 727 individuals were diagnosed with DCIS. The rate of mastectomy was 30% and was associated with multifocality (OR: 3.5 [1.7, 7.1], P = 0.0005), tumor size (OR: >2 cm vs. ≤1 cm: 2.7 [1.3, 5.9], P = 0.01), high nuclear grade (OR: 2.4 [1.1, 5.2], P = 0.03) and surgeon’s practice pattern. The rate of axillary dissection (AND) decreased from 36% in 1991–1993 to 20% in 1998–2000. AND was associated with mastectomy, year of surgery and hospital volume (OR: 2.7 [1.3, 5.6], P = 0.01). The use of radiation (XRT) following breast-conserving surgery increased from 39% in 1991␣to 51% in 2000. XRT was associated with age<70 years, high nuclear grade (OR: 2.7 [1.2, 6.3], P = 0.02) and tumor size > 1 cm (OR: 2.4 [1.3, 4.4], P = 0.006). Half of cases with margins <1 cm did not receive XRT.

Conclusions

Our study corroborates previous reports on the persistent rates of mastectomy and axillary nodal dissection and the limited use of XRT in the treatment of DCIS.

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References

  1. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbas R (2000) Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med 160:953–958

    Article  PubMed  CAS  Google Scholar 

  2. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C (1996) Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 275(12):913–918

    Article  PubMed  CAS  Google Scholar 

  3. Ernster VL, Barclay J (1997) Increases in ductal carcinoma in situ (DCIS) of the breast in relation to mammography: a dilemma [review] [34 Refs]. J Natl Cancer Inst Monogr (22):151–156

  4. Silverstein MJ (1997) Van nuys experience by treatment. In: Silverstein MJ (Eds), Ductal carcinoma in situ. Williams & Wilkins, Baltimore, pp 443–447

    Google Scholar 

  5. Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, Fisher ER, Wickerham DL, Deutsch M, Margolese R, Dimitrov N, Kavanah M (1998) Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from national surgical adjuvant breast and bowel project B-17. J Clin Oncol 16(2):441–452

    PubMed  CAS  Google Scholar 

  6. Fourquet A, Zafrani B, Campana F, Clough KB (1997) Institute curie experience. In: Silverstein MJ (Eds.), Ductal carcinoma in situ. Williams & Wilkins, Baltimore, pp 385–390

    Google Scholar 

  7. Solin LJ, Kurtz J, Fourquet A, Amalric R, Recht A, Bornstein BA, Kuske R, Taylor M, Barrett W, Fowble B, Haffty B, Schultz DJ, Yeh IT, McCormick B, McNeese M (1996) Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol 14(3):754–763

    PubMed  CAS  Google Scholar 

  8. Lagios MD (1996) Duct carcinoma in situ: biological implications for clinical practice [review] [31 Refs]. Semin Oncol 23(1 Suppl 2):6–11

    PubMed  CAS  Google Scholar 

  9. Holland R, Hendriks JH, Vebeek AL, Mravunac M, Schuurmans Stekhoven JH (1990) Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet 335(8688):519–522

    Article  PubMed  CAS  Google Scholar 

  10. Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European organization for research and treatment of cancer (EORTC), Breast cancer co-operative group (BCCG). Eur J Cancer 34(3):307–314

    Article  PubMed  CAS  Google Scholar 

  11. Ratanawichitrasin A, Rybicki LA, Steiger E, Grundfest-Broniatowski S, Hermann RE, Crowe JP (1999) Predicting the likelihood of residual disease in women treated for ductal carcinoma in situ. J Am Coll Surg 188(1):17–21

    Article  PubMed  CAS  Google Scholar 

  12. Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, Avril A, Sylvester R, Mignolet F, Bartelink H, van Dongen JA (2000) Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC breast cancer cooperative group and EORTC radiotherapy group. Lancet 355(9203):528–533

    Article  PubMed  CAS  Google Scholar 

  13. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS, Spittle M (2003) UK coordinating committee on cancer research, ductal carcinoma in situ working party, and DCIS trialists in the UK, Australia and New Zealand. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New␣Zealand: randomised controlled trial. Lancet 362(9378):95–102

    Article  PubMed  Google Scholar 

  14. Hansen N, Giuliano AE (1997) Axillary dissection for ductal carcinoma in situ. In: Silverstein MJ (Eds) Ductal carcinoma in situ. Williams and Wilkins, Baltimore, pp 577–584

    Google Scholar 

  15. Steering Committee on Clinical Practice Guidelines for the Care, Treatment of Breast Cancer (1998) The management of ductal carcinoma in situ (DCIS). Can Med Assoc J 158(3 Suppl):S27–S34

    Google Scholar 

  16. Baxter NN, Virnig BA, Durham SB, Tuttle TM (2004) Trends in the treatment of ductal carcinoma in situ of the breast. J Nat Cancer Inst 96(6):443–448

    PubMed  Google Scholar 

  17. O’Connor GT, Quinton HB, Traven ND, Ramunno LD, Dodds TA, Marciniak TA, Wennberg JE (1999) Geographic variation in the treatment of acute myocardial infarction: the cooperative cardiovascular project. JAMA 281(7):627–633

    Article  PubMed  CAS  Google Scholar 

  18. Potosky AL, Merrill RM, Riley GF, Taplin SH, Barlow W, Fireman BH, Barbash R (1997) Breast cancer survival and treatment in health maintenance organization and fee-for-service settings. JNCI Cancer Spectrum 89(22):1683–1691

    Article  CAS  Google Scholar 

  19. Goel V, Olivotto I, Hislop TG, Sawka C, Coldman A, Holowaty EJ (1997) Patterns of initial management of node-negative breast cancer in two Canadian provinces. British Columbia/Ontario working group. CMAJ 156(1):25–35

    PubMed  CAS  Google Scholar 

  20. Schroen AT, Brenin DR, Kelly MD, Knaus WA, Slingluff CL Jr (2005) Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol 23(28):7074–7080

    Article  PubMed  Google Scholar 

  21. Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, Gamagami P, Colburn WJ (1999) The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 340(19):1455–1461

    Article  PubMed  CAS  Google Scholar 

  22. Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42(1):121–130

    Article  PubMed  CAS  Google Scholar 

  23. Eusebi V, Feudale E, Foschini MP, Micheli A, Conti A, Riva C, Di Palma S, Rilke F (1994) Long-term follow-up of in situ carcinoma of the breast. Semin Diagn Pathol 11(3):223–235

    PubMed  CAS  Google Scholar 

  24. Page DL, Dupont WD, Rogers LW, Jensen RA, Schuyler PA (1995) Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer 76(7):1197–1200

    Article  PubMed  CAS  Google Scholar 

  25. Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, Wolmark N (1999) Pathologic findings from the National surgical adjuvant breast project (NSABP) eight-year update of protocol B-17: intraductal carcinoma. Cancer 86(3):429–438

    Article  PubMed  CAS  Google Scholar 

  26. Lagios MD, Silverstein MJ (2001) Sentinel node biopsy for patients with DCIS: a dangerous and unwarranted direction [Editorial]. Ann Surg Oncol 8(4):275–277

    Article  PubMed  CAS  Google Scholar 

  27. Lagios MD, Margolin FR, Westdahl PR, Rose MR (1989) Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 63(4):618–624

    Article  PubMed  CAS  Google Scholar 

  28. Solin LJ, Schultz DJ, Fowble BL (1995) Ten-Year results of the treatment of early-stage breast carcinoma in elderly women using breast-conserving surgery and definitive breast irradiation. Int J Radiat Oncol Biol Phys 33(1):45–51

    Article  PubMed  CAS  Google Scholar 

  29. Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, Wolmark N, Wickerham DL, Deutsch M, Ore L (1993) Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 328(22):1581–1586

    Article  PubMed  CAS  Google Scholar 

  30. Rakovitch E, Franssen E, Kim J, Ackerman I, Pignol JP, Paszat L, Pritchard KI, Ho C, Redelmeier DAA (2003) Comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer [Report]. Breast Cancer Res Treat 77(3):285–293

    Article  PubMed  Google Scholar 

  31. SchwartzGF (1994) The role of excision and surveillance alone in subclinical DCIS of the breast. Oncology (Huntingt) 8(2):21–26 discussion

    Google Scholar 

  32. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, Poller DN (1996) A prognostic index for ductal carcinoma in situ of the breast. Cancer 77(11):2267–2274

    Article  PubMed  CAS  Google Scholar 

  33. Silverstein MJ, Lagios MD, Martino S, Lewinsky BS, Craig PH, Beron PJ, Gamagami P, Waisman JR (1998) Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast. J Clin Oncol 16(4):1367–1373

    PubMed  CAS  Google Scholar 

  34. Solin LJ, Fourquet A, McCormick B, Haffty B, Recht A, Schultz DJ, Barrett W, Fowble BL, Kuske R, Taylor M (1994) Salvage treatment for local recurrence following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (intraductal carcinoma) of the breast. Int J Radiat Oncol Biol Phys 30(1):3–9

    PubMed  CAS  Google Scholar 

  35. Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, Salem B, Lakhani I, Morrow M (2005) Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol 23(24):5526–5533

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from the Canadian Breast Cancer Foundation and the Canadian Breast Cancer Research Alliance. The authors would like to thank Ms. Barb Zurowski for her assistance in manuscript preparation and Ms. Angela Uzun for her assistance at the OBSP.

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Authors and Affiliations

  1. Department of Radiation Oncology and Health Policy and Evaluation, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont., Canada

    Eileen Rakovitch, Jean-Philippe Pignol, Carole Chartier & Lawrence Paszat

  2. Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont., Canada

    Wedad Hanna, Hariette Kahn & John Wong

  3. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont., Canada

    Lawrence Paszat

  4. Institute of Clinical Evaluative Services, Toronto, Ont., Canada

    Carole Chartier & Lawrence Paszat

  5. Ontario Breast Screening Program, Toronto, Ont., Canada

    Verna Mai

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  1. Eileen Rakovitch
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Correspondence to Eileen Rakovitch.

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Rakovitch, E., Pignol, JP., Chartier, C. et al. The management of ductal carcinoma in situ of the breast: a screened population-based analysis. Breast Cancer Res Treat 101, 335–347 (2007). https://doi.org/10.1007/s10549-006-9302-0

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  • DOI: https://doi.org/10.1007/s10549-006-9302-0

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