Annals of Surgical Oncology

, Volume 2, Issue 3, pp 207–213 | Cite as

Treatment trends for ductal carcinoma in situ of the breast

  • David P. Winchester
  • Herman R. Menck
  • Robert T. Osteen
  • William Kraybill
Original Articles

Abstract

Background: As a result of clinical trial publications, breast conservation treatment has been increasingly used for invasive breast cancer. The patterns of care for ductal carcinoma in situ (DCIS) were analyzed for the years 1985, 1986, 1988, 1990, and 1991 to determine whether the same treatment principles had been applied to patients with noninvasive disease.

Methods: Data submitted on 20,556 patients with DCIS during the 5 study years were analyzed with regard to basic demographics and treatment trends.

Results: Breast-conserving surgery for DCIS increased from 20.9% in 1985 to 35.4% in 1991. Modified radical mastectomy remained constant at 42%. Axillary node surgery increased from 52% in 1985 to 58.5% in 1991. The use of radiation therapy for patients with partial mastectomy and no lymph node dissection ranges from 24.2% in 1990 to 37.7% in 1985, with 31.1% receiving radiation therapy in 1991. Patients undergoing lymph node dissection with partial mastectomy were more than twice as likely to receive postoperative radiation therapy than were patients without lymph node dissection.

Conclusions: Modified radical mastectomy remains the most common surgical procedure, despite the eligibility of many women for breast conservation treatment. As of 1991 the majority of women were still undergoing axillary lymph node surgery despite a node positivity rate of ≈1%. Radiation therapy is significantly underused in patients with partial mastectomy, especially when no nodes were removed. Clinical trial results and professional education for DCIS treatment should change these trends.

Key Words

Treatment trends Ductal carcinoma in situ Breast Breast conservation treatment 

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References

  1. 1.
    Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1989;320:822–8.PubMedGoogle Scholar
  2. 2.
    Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection and radiotherapy in early breast cancer: long-term results.Eur J Cancer Clin Oncol 1986;22:1085–9.PubMedGoogle Scholar
  3. 3.
    Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer.Radiother Oncol 1989;14:177–84.CrossRefPubMedGoogle Scholar
  4. 4.
    Blichert-Toft M. A Danish randomized trial comparing breast conservation with mastectomy in mammary carcinoma.Br J Cancer 1990;62(suppl 12):15.Google Scholar
  5. 5.
    Blichert-Toft M, Brincker H, Andersen JA, et al. A Danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma: preliminary results.Acta Oncol 1988;27:671–7.PubMedGoogle Scholar
  6. 6.
    Bader J, Lippman ME, Swain SM, et al. Preliminary report of the NCI early breast cancer (BC) study: a prospective randomized comparison of lumpectomy (L) and radiation (XRT) to mastectomy (M) for stage I and II BC (abstr).Int J Radiat Oncol Biol Phys 1987;13(suppl 1):160.Google Scholar
  7. 7.
    Glatstein E. Straus K, Lichter A, et al. Results of the NCI early breast cancer trial (abstr). Proceedings of the NIH Consensus Development Conference, June 18–21, 1990:32–33.Google Scholar
  8. 8.
    Bartelink H, van Dongen JA, Aaronson N, et al. Randomized clinical trial to assess the value of breast conserving therapy (BCT) in stage II breast cancer; EORTC Trial 10801 (abstr). Proceedings of the 7th Annual Meeting of the European Society of Therapeutic Radiology and Oncology (ESTRO), Den Haag, the Netherlands, 1988:221.Google Scholar
  9. 9.
    van Dongen JA, Bartelink H, Aaronson H, et al. Randomized clinical trial to assess the value of breast conserving therapy in stage I and stage II breast cancer; EORTC Trial 10801 [Abstract]. Proceedings of the NIH Consensus Development Conference, June 18–21, 1990:25–7.Google Scholar
  10. 10.
    Habibollahi F, Fentiman IS, Chaudary MA, et al. Conservation treatment of operable breast cancer [Abstract].Proc Am Soc Clin Oncol 1987;6:A231.Google Scholar
  11. 11.
    Wilson RE, Donegan WL, Mettlin C, Smart CR, Murphy GP. The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons.Surg Gynecol Obstet 1984;159:309–18.PubMedGoogle Scholar
  12. 12.
    Osteen RT, Steele GD, Menck HR, Winchester DP. Regional differences in surgical management of breast cancer.CA 1992;42:39–43.PubMedGoogle Scholar
  13. 13.
    Coleman EA, Kessler LG, Wun L-M, et al. Trends in the surgical treatment of ductal carcinoma in situ of the breast.Am J Surg 1992;164:74–6.PubMedGoogle Scholar
  14. 14.
    Winchester DP. Standards of care in breast cancer diagnosis and treatment.Surg Oncol Clin North Am 1994;3:85–99.Google Scholar
  15. 15.
    Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer.N Engl J Med 1993;328:1581–6.PubMedGoogle Scholar
  16. 16.
    Silverstein MJ, Rosser RJ, Gierson ED, et al. Axillary lymph node dissection for intraductal breast carcinoma—is it indicated?Cancer 1987;59(10):1819–24.PubMedGoogle Scholar
  17. 17.
    Cady B. Duct carcinoma in situ: breast cancer in high-risk patients.Surg Oncol Clin North Am 1993;2:75–89.Google Scholar
  18. 18.
    Lagios MD, Margolin FR, Westdahl PR, et al. Mammographically detected duct carcinoma in situ: frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence.Cancer 1989;63:618–24.PubMedGoogle Scholar
  19. 19.
    Schwartz GF, Finkel GC, Garcia JC, et al. Subclinical ductal carcinoma in situ of the breast: treatment by local excision and surveillance alone.Cancer 1992;70:2468–74.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 1995

Authors and Affiliations

  • David P. Winchester
    • 1
  • Herman R. Menck
    • 1
  • Robert T. Osteen
    • 1
  • William Kraybill
    • 1
  1. 1.From the Commission on CancerAmerican College of SurgeonsChicagoUSA

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