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-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.
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).
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.
KeywordsDuctal carcinoma in situ (DCIS) Adjuvant therapy Radiotherapy Endocrine therapy
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.
This study was funded in part by Breast Cancer Research Foundation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest concerning this study.
- 3.Virnig BA, Shamliyan T, Tuttle TM et al (2009) Diagnosis and management of ductal carcinoma in situ (DCIS). Evid Rep Technol Assess (Full Rep). 185:1–549Google Scholar
- 5.Sagara Y, Freedman RA, Vaz-Luis I et al (2016) Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ: a population-based longitudinal cohort study. J Clin Oncol 34(11):1190–1196. doi: 10.1200/JCO.2015.65.1869 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.NCCN Clinical Practice Guidelines in Oncology—Breast Cancer version 2. 2017. National Comprehensive Cancer Network. http://www.nccn.com. Accessed 24 May 2017
- 13.American College of Surgeons: National Cancer Database. American College of Surgeons. https://www.facs.org/quality-programs/cancer/ncdb. Accessed 24 May 2017
- 14.Silverstein MJ, Lagios MD, Craig PH et al (1996) A prognostic index for ductal carcinoma in situ of the breast. Cancer 77(11):2267–2274. doi: 10.1002/(SICI)1097-0142(19960601)77:11<2267:AID-CNCR13>3.0.CO;2-V CrossRefPubMedGoogle Scholar
- 22.Allred DC, Anderson SJ, Paik S et al (2012) Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol 30(12):1268–1273. doi: 10.1200/JCO.2010.34.0141 CrossRefPubMedPubMedCentralGoogle Scholar