Cancer Causes & Control

, Volume 30, Issue 2, pp 129–136 | Cite as

Trends in lobular carcinoma in situ management: endocrine therapy use in California and New Jersey

  • Schelomo MarmorEmail author
  • Bonnie Jerome-D’Emilia
  • James W. Begun
  • Jane Yuet Ching Hui
  • Ariella M. Altman
  • Scott Kizy
  • Todd M. Tuttle
Original Paper



The diagnosis of lobular carcinoma in situ (LCIS) is a strong risk factor for breast cancer. Endocrine therapy (ET) for LCIS has been shown to decrease breast cancer risk substantially. The purpose of this study was to evaluate the trends of ET use for LCIS in two large geographic locations.

Patients and methods

We identified women, ages 18 through 75, with a microscopic diagnosis of LCIS in California (CA) and New Jersey (NJ) from 2004 to 2014. We evaluated trends in unadjusted ET rates during the study period and used logistic regression to evaluate the relationship between patient, tumor, and treatment characteristics, and ET use.


We identified 3,129 patients in CA and 2,965 patients in NJ. The overall use of ET during the study period was 14%. For the combined sample, women in NJ were significantly less likely to utilize ET then their counterparts in CA (OR 0.77, CI 0.66–0.90, NJ vs. CA). In addition, patients in the later year period (OR 1.27, CI 1.01–1.59, 2012–2014 vs. 2004–2005) and women who received an excisional biopsy (OR 2.35, CI 1.74–3.17), were more likely to utilize ET. Uninsured women were less likely to receive ET (OR 0.61, CI 0.44–0.84, non-insured vs. insured status).


We observed that an increasing proportion of women are using ET for LCIS management, but geographical differences exist. Health insurance status played an important role in the underutilization of ET. Further research is needed to assess patient outcomes given the variations in management of LCIS.


LCIS Endocrine therapy (ET) Geographic variation 



We thank Antoinette M. Stroup, Ph.D., Director of the New Jersey State Cancer Registry for her assistance in reviewing this manuscript. We also thank the California Cancer Registry; the New Jersey State Cancer Registry, Cancer Epidemiology Services; New Jersey Department of Health, which is funded by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute under Contract HHSN261201300021I; the National Program of Cancer Registries (NPCR); Centers for Disease Control and Prevention under Grant 5U58DP003931-02 as well as the State of New Jersey and the Rutgers Cancer Institute of New Jersey.

Author contributions

SM: Conceptualization, methodology, validation, formal analysis, investigation, data curation, writing-original draft, visualization. Bonnie J-D’E: Conceptualization, investigation, resources, data curation, writing-original draft, visualization. JB: Validation, visualization, and writing-review and editing. JYCH: Conceptualization, writing-review and editing, and visualization. AA: Validation, visualization, and writing-review and editing. SK: Validation, visualization, and writing-review and editing. TMT: Conceptualization, methodology, validation, writing-original draft, writing-review and editing, supervision, project administration, resources, and visualization.


This publication was supported by the Grant or Cooperative Agreement Number, NU58DP006279, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose.


  1. 1.
    King TA, Pilewskie M, Muhsen S, Patil S, Mautner SK, Park A, Oskar S et al (2015) Lobular carcinoma in situ: a 29-year longitudinal experience evaluating clinicopathologic features and breast cancer risk. J Clin Oncol 33:3945–3952CrossRefGoogle Scholar
  2. 2.
    Portschy PR, Marmor S, Nzara R, Virnig BA, Tuttle TM (2013) Trends in incidence and management of lobular carcinoma in situ: a population-based analysis. Ann Surg Oncol 20(10):3240–3246. CrossRefGoogle Scholar
  3. 3.
    Parkin CKE, Garewal S, Waugh P, Maxwell AJ (2014) Outcomes of patients with lobular in situ neoplasia of the breast: the role of vacuum-assisted biopsy. Breast 23(5):651–655. Epub 2014 Jul 22CrossRefGoogle Scholar
  4. 4.
    Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ et al (2017) NCCN guidelines insights: breast cancer, version 1.2017. J Natl Compr Cancer Netw 15(4):433–451CrossRefGoogle Scholar
  5. 5.
    Chester R, Bokinni O, Ahmed I, Kasem A (2015) UK national survey of management of breast lobular carcinoma in situ. Ann R Coll Surg 97(8):574–577. CrossRefGoogle Scholar
  6. 6.
    Chuba PJ, Hamre MR, Yap J et al (2005) Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol 23:5534–5541CrossRefGoogle Scholar
  7. 7.
    Ward EM, DeSantis CE, Lin CC, Kramer JL, Jemal A et al (2015) Cancer statistics: breast cancer in situ. CA: Cancer J Clin 65(6):481–495. Google Scholar
  8. 8.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M et al (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. JNCI 90(18):1371–1388CrossRefGoogle Scholar
  9. 9.
    Bambhroliya A, Chavez-MacGregor M, Brewster AM (2015) Barriers to the use of breast cancer risk reduction therapies. J Natl Compr Cancer Netw 13(7):927–935CrossRefGoogle Scholar
  10. 10.
    Crew KD, Albain KS, Hershman DL, Unger JM, Lo SS (2017) How do we increase uptake of tamoxifen and other anti-estrogens for breast cancer prevention? NPJ Breast CA 3:20. CrossRefGoogle Scholar
  11. 11.
    Nazarali SA, Narod SA (2014) Tamoxifen for women at high risk of breast cancer. Breast Cancer 6:29–36. Google Scholar
  12. 12.
    Jerome-D’Emilia B, Suplee PD, Akincigil A (2015) Validation of the Spanish version of the mammography specific self-efficacy scale. Oncol Nurs Forum 42(3):E279–E286CrossRefGoogle Scholar
  13. 13.
    Farkas DT, Greenbaum A, Singhal V, Cosgrove JM (2012) Effect of insurance status on the stage of breast and colorectal cancers in a safety-net hospital. J Oncol Pract 8(3 Suppl):16s–21s. CrossRefGoogle Scholar
  14. 14.
    Pesce CE, Liederbach E, Czechura T, Winchester DJ, Yao K (2014) Changing surgical trends in young patients with early stage breast cancer, 2003 to 2010: a report from the National Cancer Database. J Am Coll Surg 219(1):19Y28CrossRefGoogle Scholar
  15. 15.
    Shi R, Taylor H, McLarty J, Liu L, Mills G, Burton G (2015) Effects of payer status on breast cancer survival: a retrospective study. BMC Cancer 15(1):211. CrossRefGoogle Scholar
  16. 16.
    Smith SG, Sestak I, Forster A, Partridge A, Side L et al (2015) Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis. Ann Oncol 27(4):575–590CrossRefGoogle Scholar
  17. 17.
    Kinney AY, Richards C, Vernon SW, Vogel VG (1998) The effect of physician recommendation on enrollment in the breast cancer chemoprevention trial. Prev Med 27(5):713–719CrossRefGoogle Scholar
  18. 18.
    Yeomans-Kinney A, Vernon SW, Frankowski RF Weber DM, Bitsura JM, Vogel VG (1995) Factors related to enrollment in the breast cancer prevention trial at a comprehensive cancer center during the first year of recruitment. Cancer 76(1): 46–56.;2-B.CrossRefGoogle Scholar
  19. 19.
    Martinez KA, Fagerlin A, Witteman HO, Holmberg C, Hawley ST (2016) What matters to women when making decisions about chemoprevention? The Patient 9(2):149–159. CrossRefGoogle Scholar
  20. 20.
    Hum S, Wu M, Pruthi S, Heisey R (2016) Physician and patient barriers to breast cancer preventive therapy. Curr Breast CA Rep 8(3):158–164CrossRefGoogle Scholar
  21. 21.
    Padamsee TJ, Wills CE, Yee LD, Paskett ED (2017) Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 19(1):34. CrossRefGoogle Scholar
  22. 22.
    Almeida RA, Dubay LC, Ko G (2001) Access to care and use of health services by low-income women. Health Care Financ Rev 22(4):27–47Google Scholar
  23. 23.
    Kaiser Family Foundation (2017) Data note: three findings about access to care and health outcomes in medicaid. Accessed 20 Jan 2018
  24. 24.
    Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM et al (2005) Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. JNCI 97(22):1652–1662CrossRefGoogle Scholar
  25. 25.
    Brewster AM, Christo DK, Lai H, Helzlsouer K (2005) Breast carcinoma chemoprevention in the community setting. Estimating risks and benefits. Cancer 15:1147–1153CrossRefGoogle Scholar
  26. 26.
    Kadakia KC, Henry NL (2015) Adjuvant endocrine therapy in premenopausal women with breast cancer. Clin Adv Hematol Oncol 13(10):663Google Scholar
  27. 27.
    Messalli EM, Scaffa C (2009) Long-term safety and efficacy of raloxifene in the prevention and treatment of postmenopausal osteoporosis: an update. Int J Women’s Health 1:11CrossRefGoogle Scholar
  28. 28.
    Takeuchi Y, Hamaya E, Taketsuna M, Sowa H (2015) Safety of 3-year raloxifene treatment in Japanese postmenopausal women aged 75 years or older with osteoporosis: a postmarketing surveillance study. Menopause 22(10):1134–1137CrossRefGoogle Scholar
  29. 29.
    Waters EA, McNeel TS, Stevens WM, Freedman AN (2012) Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010. Breast Cancer Res Treat 134(2):875–880. CrossRefGoogle Scholar
  30. 30.
    Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY, Fehrenbacher L, Lin Gomez S, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28(27):4120–4128CrossRefGoogle Scholar
  31. 31.
    Bober SL, Hoke LA, Duda RB, Regan MM, Tung NM (2004) Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors. J Clin Oncol 22(24):4951–4957CrossRefGoogle Scholar
  32. 32.
    Jerome-D’Emilia B, Begun JW (2005) Diffusion of breast conserving surgery in medical communities. Soc Sci Med 60(1):143–151CrossRefGoogle Scholar
  33. 33.
    Shahbazi S, Woods SJ (2016) Influence of physician, patient, and health care system characteristics on the use of outpatient mastectomy. Am J Surg 211(4):802–809CrossRefGoogle Scholar
  34. 34.
    Waljee JF, Hawley S, Alderman AK, Morrow M, Katz SJ (2007) Patient satisfaction with treatment of breast cancer: does surgeon specialization matter? J Clin Oncol 25(24):3694–3698CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Schelomo Marmor
    • 1
    Email author
  • Bonnie Jerome-D’Emilia
    • 2
  • James W. Begun
    • 3
  • Jane Yuet Ching Hui
    • 1
  • Ariella M. Altman
    • 1
  • Scott Kizy
    • 1
  • Todd M. Tuttle
    • 1
  1. 1.Department of SurgeryUniversity of MinnesotaMinneapolisUSA
  2. 2.Rutgers University School of Nursing - CamdenCamdenUSA
  3. 3.Department of Health Policy and ManagementUniversity of MinnesotaMinneapolisUSA

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