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Trends in adjuvant therapy after breast-conserving surgery for ductal carcinoma in situ of breast: a retrospective cohort study using the National Breast Cancer Registry of Japan

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Abstract

Purpose

Radiotherapy (RT) and endocrine therapy (ET) are standard treatment options after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We investigated the national patterns of adjuvant therapy use after BCS for DCIS in Japan.

Methods

We obtained relevant data of patients diagnosed with DCIS undergoing surgery and treated with BCS between 2014 and 2016 from the Japanese Breast Cancer Registry database. The relationship between the clinicopathologic, institutional, and regional factors, and adjuvant treatment was examined using multivariable analyses.

Results

We identified 9516 patients who underwent BCS for DCIS. Overall, 23% received no adjuvant treatment, 71% received RT, 32% received ET, and 26% received combination therapy. The percentages of patients who received ET and combination therapy in 2016 were significantly lower [odds ratio (OR): 0.71, 0.77, respectively] than in 2014. The proportion of RT was low among young or elderly patients (OR: 0.75, 0.44, respectively) and in non-certified facilities (OR: 0.56). The proportion of ET was high in non-certified facilities (OR: 1.58) and among patients with positive margins (OR: 1.62). Combination therapy was higher among patients with positive margins (OR: 1.53).

Conclusions

Our study found a distinct adjuvant treatment pattern after BCS for DCIS depending on clinicopathologic factors, year, age, which indicate that physicians provide individualized treatment according to the background of the patients and the biology of DCIS. The facilities and regions remain significant factors of influencing adjuvant treatment pattern.

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Abbreviations

BCS:

Breast-conserving surgery

DCIS:

Ductal carcinoma in situ

ET:

Endocrine therapy

IBTR:

Ipsilateral breast tumor recurrence

JBCS:

Japanese Breast Cancer Society

RT:

Radiotherapy

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Acknowledgements

This report was supported in part by the National Cancer Center Research and Development fund (26-A-4) from the Ministry of Health, Labour and Welfare and the Practical Research for Innovative Cancer Control (19ck0106307h0002) from the Japan Agency for Medical Research and Development, AMED. The grammatical assistance was performed by professional editors at Editage, a division of Cactus Communications (www.editage.com).

Author information

Authors and Affiliations

  1. Department of Breast Surgery, Sagara Hospital Miyazaki, Miyazaki Hakuaikai Medical Corporation, Miyazaki, Japan

    Daisuke Yotsumoto

  2. Department of Breast Surgery, Sagara Hospital, Hakuaikai Medical Corporation, 3-28 Matsubara Kagoshima City, Kagoshima, 892-0833, Japan

    Yasuaki Sagara

  3. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Hiraku Kumamaru & Hiroaki Miyata

  4. Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan

    Naoki Niikura

  5. Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan

    Chizuko Kanbayashi

  6. Department of Basic Pathology, National Defense Medical College, Saitama, Japan

    Hitoshi Tsuda

  7. Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Yutaka Yamamoto

  8. Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan

    Kenjiro Aogi

  9. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Makoto Kubo

  10. Department of Medical Oncology, Shimane University Hospital, Izumo, Shimane, Japan

    Kenji Tamura

  11. Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Naoki Hayashi

  12. Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Minoru Miyashita

  13. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Takayuki Kadoya

  14. Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan

    Shigehira Saji

  15. Breast Cancer Unit, Graduate School of Medicine, Kyoto University Hospital Breast Surgery, Kyoto University, Kyoto, Japan

    Masakazu Toi

  16. Department of Breast Surgery, Kyorin University School of Medicine, Tokyo, Japan

    Shigeru Imoto

  17. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Hiromitsu Jinno

Authors
  1. Daisuke Yotsumoto
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  2. Yasuaki Sagara
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  3. Hiraku Kumamaru
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  7. Hitoshi Tsuda
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  13. Minoru Miyashita
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  15. Shigehira Saji
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  16. Masakazu Toi
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Corresponding author

Correspondence to Yasuaki Sagara.

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Conflict of interest

Hiraku Kumamaru and Hiroaki Miyata are affiliated with the department of Healthcare Quality Assessment at the university of Tokyo. The department is a social collaboration department supported by National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation. Naoki Niikura has received grants and personal fees from Chugai, Pfizer, Eisai, Daiichi Sankyo, MSD, grants from Novartis, Eisai, AstraZeneka, Kyowa Hakko Kirin, Nippon Mediphysics, Takeda, Taiho, Nippon Kayaku, Eli Lilly. Hitoshi Tsuda has received grants from Taiho, Goryo Chemical, personal fees and other from Chugai, other from Takeda, Eli Lilly. Yutaka Yamamoto has received grants and personal fees from Chugai, Kyowa Hakko Kirin, Eli Lilly, Nihon Kayaku, personal fees from Taiho, Daiichi Sankyo, AstraZeneca, Novartis, Eisai, Takeda, Pfizer. Naoki Hayashi has received personal fees from Chugai, Novartis, Pfizer, Daiichi Sankyo, AstraZeneca, Genomic Health inc. Minoru Miyashita has received personal fees from Chugai, Eli Lilly, Eisai, AstraZeneca, Pfizer, Taiho, Daiichi Sankyo, non-financial support from Kyowa Hakko Kirin. Kenjiro Aogi has received personal fees as honoraria from Chugai, Eisai, AstraZeneca, Taiho, Novartis, Daiichi Sankyo, Mochida, Ono, Eli Lilly, and his institution received research funds from Chuai, Eisai, Takeda. Shigehira Saji has received grants and personal fees from Chugai, Kyowa Hakko Kirin, Eli Lilly, AstraZeneca, Novartis, Eisai, Takeda, personal fees from Pfizer, MSD, Daiichi Sankyo, grants from Taiho. Masakazu Toi has received grants and personal fees from Chugai, Takeda, Pfizer, Kyowa Hakko Kirin, C & C Res Lab, Taiho, Eisai, Daiichi Sankyo, AstraZeneca, grants from JBCRG association, Astellas, personal fees from Eli Lilly, MSD, Genomic Health, Novartis, Konica Minolta, outside the submitted work; and Board of directors; JBCRG association, Organization for Oncology and Translational Research, Kyoto Breast cancer Research Network. The other authors have no conflict of interest.

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Yotsumoto, D., Sagara, Y., Kumamaru, H. et al. Trends in adjuvant therapy after breast-conserving surgery for ductal carcinoma in situ of breast: a retrospective cohort study using the National Breast Cancer Registry of Japan. Breast Cancer 29, 1–8 (2022). https://doi.org/10.1007/s12282-021-01307-z

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