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Trends in adjuvant therapies after breast-conserving surgery for hormone receptor-positive ductal carcinoma in situ: findings from the National Cancer Database, 2004–2013

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

Abstract

Purpose

Breast-conserving surgery (BCS) followed by radiotherapy (RT) with or without endocrine therapy (ET) is a standard treatment option for ductal carcinoma in situ (DCIS). We sought to investigate national patterns in the use of adjuvant therapy after BCS for hormone receptor (HR)-positive DCIS over time.

Patients and methods

Using data from the National Cancer Data Base, we identified patients diagnosed with DCIS and treated with BCS between 2004 and 2013. Multivariable logistic regression was used to estimate the odds of adjuvant therapy use controlling for clinicopathologic demographic and facility-level characteristics.

Results

We identified 66,079 patients who underwent BCS for DCIS. Overall, 21% received no adjuvant treatment, 71% received RT, 48% received ET, and 38% received the combination therapy. In adjusted analyses among the patients with HR-positive DCIS (n = 50,147), the administration of RT decreased (odds ratio [OR] 0.86, 95% CI 0.77–0.97), while the use of ET increased (OR 1.5, 95% CI 1.4–1.6) in 2013 compared to 2004. Young patients, elderly patients, positive margin status, and Medicare insurance were associated with lower use of both RT and ET. We observed both clinicopathologic and geographic variation in the use of adjuvant therapies. In the lowest risk subgroup, the use of RT decreased from 57% in 2004 to 48% in 2013 (OR 0.64, 95% CI 0.45–0.89).

Conclusion

Our study suggests a shift in patterns of care for DCIS that is impacted by both clinicopathologic and demographic factors, with the use of RT decreasing and the use of ET increasing in HR-positive DCIS patients. Current trials are designed to address the possible over-treatment of low-risk DCIS.

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Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

This study was funded in part by Breast Cancer Research Foundation.

Author information

Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Yasuaki Sagara, Anvy Nguyen & Mehra Golshan

  2. Harvard T.H Chan School of Public Health, Boston, MA, USA

    Yasuaki Sagara

  3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Rachel A. Freedman

  4. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Stephanie M. Wong

  5. Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey

    Fatih Aydogan

  6. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    William T. Barry

  7. Dana-Farber/Brigham and Women’s Cancer Center, 450 Brookline Avenue, Boston, MA, 02215, USA

    Mehra Golshan

Authors
  1. Yasuaki Sagara
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  2. Rachel A. Freedman
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  3. Stephanie M. Wong
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  4. Fatih Aydogan
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Correspondence to Mehra Golshan.

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The authors declare that they have no conflict of interest concerning this study.

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Sagara, Y., Freedman, R.A., Wong, S.M. et al. Trends in adjuvant therapies after breast-conserving surgery for hormone receptor-positive ductal carcinoma in situ: findings from the National Cancer Database, 2004–2013. Breast Cancer Res Treat 166, 583–592 (2017). https://doi.org/10.1007/s10549-017-4436-9

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