Breast Cancer Research and Treatment

, Volume 127, Issue 1, pp 251–257 | Cite as

Ductal carcinoma in situ: trends in treatment over time in the US

  • Jo Anne Zujewski
  • Linda C. Harlan
  • Donna M. Morrell
  • Jennifer L. Stevens


To describe therapy and changes in therapy over time for women diagnosed with ductal carcinoma in situ (DCIS) and treated in the community setting. Women aged 20 or older diagnosed with DCIS in this study were sampled from the population-based Surveillance, Epidemiology and End Results Program. A total of 770, 1055, 480, and 404 women with DCIS were selected in 1991, 1995, 2000, or 2005, respectively. Most women do not have nodal sampling, but between 2000 and 2005 there was an increase in the use of sentinel node biopsy, 9 and 22%, respectively. Of the DCIS patients, 80% had no or unknown HER-2 assays, 12% were postitive, 7% negative, and 1% equivocal. After adjusting for tumor size, age, race, marital status, and insurance there has been a decrease in mastectomy since 1991. Of women with DCIS 36% were given tamoxifen in 2000; in 2005 this decreased to about 21%. However, in 2005 we see the use of aromatase inhibitors in nearly 4% of patients. HER-2 testing is increasingly performed for women with DCIS. Despite positive HER-2 tests no women received trastuzumab as of 2005. Despite the lack of clinical trials evidence, aromatase inhibitors are being prescribed for women with DCIS.


DCIS Population-based Treatment Surgery Hormonal therapy Female 



The authors would like to thank the SEER registries; without their contributions this work could not be done.


N01-PC-35133, N01-PC-35135, N01-PC-35141, N01-PC-35136, N01-PC-35137, N01-PC-35138, N01-PC-35139, N01-PC-35142, N01-PC-35143, N01-PC-35145, N01-PC-54402, N01-PC-54403, N01-PC-54404, N01-PC-54405.


  1. 1.
    Erbas B, Provenzano E, Armes J, Gertig D (2006) The natural history of ductal carcinoma in situ of the breast: a review. Breast Cancer Res Treat 97:135–144PubMedCrossRefGoogle Scholar
  2. 2.
    Allegra CJ, Aberle DR, Ganschow P et al (2010) National Institutes of Health State-of-the-Science Conference statement: diagnosis and management of ductal carcinoma in situ September 22–24, 2009. J Natl Cancer Inst 102:161–169PubMedCrossRefGoogle Scholar
  3. 3.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  4. 4.
    Ravdin PM, Cronin KA, Howlader N et al (2007) The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 356:1670–1674PubMedCrossRefGoogle Scholar
  5. 5.
    Chlebowski RT, Kuller LH, Prentice RL et al (2009) Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med 360:573–587PubMedCrossRefGoogle Scholar
  6. 6.
    Fisher B, Dignam J, Wolmark N et al (1999) Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 353(9169):1993–2000PubMedCrossRefGoogle Scholar
  7. 7.
    Allred DC, Bryant J, Land S et al (2002) Estrogen receptor expression as a predictive marker of the effectiveness of tamoxifen in DCIS: findings from NSABP protocol B-24 (abstract 30). Breast Cancer Res Treat 76(S):S36Google Scholar
  8. 8.
    Fisher B, Costantino J, Redmond C et al (1993) Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 328(22):1581–1586PubMedCrossRefGoogle Scholar
  9. 9.
    Smith BD, Smith GL, Buchholz TA (2008) Controversies over the role of radiation therapy for ductal carcinoma in situ. Expert Rev Anticancer Ther 8:433–441PubMedCrossRefGoogle Scholar
  10. 10.
    Fisher ER, Land SR, Saad RS et al (2007) Pathologic variables predictive of breast events in patients with ductal carcinoma in situ. Am J Clin Pathol 128:86–91PubMedCrossRefGoogle Scholar
  11. 11.
    Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP (2010) Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 28:2038–2045PubMedCrossRefGoogle Scholar
  12. 12.
    Silverstein MJ, Lagios MD, Groshen S et al (1999) The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 340(19):1455–1461PubMedCrossRefGoogle Scholar
  13. 13.
    Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 339:941–946PubMedCrossRefGoogle Scholar
  14. 14.
    McLaughlin SA, Wright MJ, Morris KT et al (2008) Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26:5213–5219 [Erratum in: J Clin Oncol 2010; 28(10):1808]Google Scholar
  15. 15.
    Fisher B, Dignam J, Wolmark N et al (1999) Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 353:1993–2000PubMedCrossRefGoogle Scholar
  16. 16.
    Yen TWF, Hunt KK, Nadeem Q et al (2004) Physician recommendations regarding tamoxifen and patient utilization of tamoxifen after surgery for ductal carcinoma in situ. Cancer 100:942–949PubMedCrossRefGoogle Scholar
  17. 17.
    Baum M, Budzar AU, Cuzick J et al (2002) ATAC Trialists’Group. Lancet 359(9324):2131–2139 [Erratum in: Lancet 2002; 360(9344):1520]Google Scholar

Copyright information

© Springer Science+Business Media, LLC. (Outside the USA) 2010

Authors and Affiliations

  • Jo Anne Zujewski
    • 1
  • Linda C. Harlan
    • 2
  • Donna M. Morrell
    • 3
  • Jennifer L. Stevens
    • 4
  1. 1.National Cancer Institute, CTEPBethesdaUSA
  2. 2.National Cancer Institute, ARPBethesdaUSA
  3. 3.University of Southern CaliforniaLos AngelesUSA
  4. 4.Information Management ServicesSilver SpringUSA

Personalised recommendations