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Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis

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Abstract

Purpose

Lobular carcinoma in situ (LCIS) is a marker of increased risk of breast cancer. Current guidelines do not recommend mastectomy as a strategy for risk reduction for most patients with LCIS. We conducted a population-based study to evaluate national trends in incidence and management of LCIS.

Methods

Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort analysis of women diagnosed with microscopically confirmed LCIS from 2000 through 2009. We excluded patients with invasive breast cancer or ductal carcinoma in situ. We evaluated variation in treatment, including biopsy alone, excision, excision with radiation therapy, and mastectomy. We utilized logistic regression to identify time trends, demographics, and patient factors associated with mastectomy.

Results

We identified 14,048 patients diagnosed with LCIS from 2000 to 2009. The rate of LCIS incidence increased from 2.0 per 100,000 in 2000 to 2.75 per 100,000 in 2009 (38 % increase). Of these patients, 10 % underwent biopsy only, 73 % underwent excision alone, 1 % underwent excision with radiation, and 16 % underwent mastectomy. Mastectomy rates were significantly higher among white and younger women. The proportion of women with LCIS to receive mastectomy increased by 50 % from 2000 to 2009 (p < 0.01). Mastectomy rates varied significantly based on geographic region ranging from 12 to 24 %.

Conclusions

This is the first population-based analysis evaluating patterns and trends in surgical management of LCIS. Despite current recommendations, risk-reduction surgery is increasingly performed in the United States for women with LCIS.

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References

  1. Oppong BA, King TA. Recommendations for women with lobular carcinoma in situ (LCIS). Oncology (Williston Park). 2011;25(11):1051–6, 1058.

  2. Page DL, Kidd TE, Jr., Dupont WD, Simpson JF, Rogers LW. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 1991;22(12):1232–9.

    Article  PubMed  CAS  Google Scholar 

  3. Bodian CA, Perzin KH, Lattes R. Lobular neoplasia. Long-term risk of breast cancer and relation to other factors. Cancer. 1996;78(5):1024–34.

    Article  PubMed  CAS  Google Scholar 

  4. Chuba PJ, Hamre MR, Yap J, et al. Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol. 2005;23(24):5534–41.

    Article  PubMed  Google Scholar 

  5. Andersen JA. Lobular carcinoma in situ of the breast. An approach to rational treatment. Cancer. 1977;39(6):2597–602.

    Article  PubMed  CAS  Google Scholar 

  6. Goldschmidt RA, Victor TA. Lobular carcinoma in situ of the breast. Semin Surg Oncol. 1996;12(5):314–20.

    Article  PubMed  CAS  Google Scholar 

  7. Li CI, Anderson BO, Daling JR, Moe RE. Changing incidence of lobular carcinoma in situ of the breast. Breast Cancer Res Treat. 2002;75(3):259–68.

    Article  PubMed  Google Scholar 

  8. Walt AJ, Simon M, Swanson GM. The continuing dilemma of lobular carcinoma in situ. Arch Surg. 1992;127(8):904–7; discussion 907–9.

    Google Scholar 

  9. Karabakhtsian RG, Johnson R, Sumkin J, Dabbs DJ. The clinical significance of lobular neoplasia on breast core biopsy. Am J Surg Pathol. 2007;31(5):717–23.

    Article  PubMed  Google Scholar 

  10. NCCN Clinical Practice Guidelines in Oncology Breast Cancer. 2013. http://www.NCCN.com.

  11. Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9.

    Article  PubMed  Google Scholar 

  12. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.

    Article  PubMed  Google Scholar 

  13. Surveillance, Epidemiology, and End Results (SEER): about SEER. http://www.seer.cancer.gov/about/.

  14. Jones NB, Wilson J, Kotur L, Stephens J, Farrar WB, Agnese DM. Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol. 2009;16(10):2691–6.

    Article  PubMed  Google Scholar 

  15. Katipamula R, Degnim AC, Hoskin T, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27(25):4082–8.

    Article  PubMed  Google Scholar 

  16. McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16(10):2682–90.

    Article  PubMed  Google Scholar 

  17. Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16(6):1597–605.

    Article  PubMed  Google Scholar 

  18. Cangiarella J, Guth A, Axelrod D, et al. Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy? A report of 38 cases and review of the literature. Arch Pathol Lab Med. 2008;132(6):979–83.

    PubMed  Google Scholar 

  19. Giuliano AE, Boolbol S, Degnim A, Kuerer H, Leitch AM, Morrow M. Society of Surgical Oncology: position statement on prophylactic mastectomy. Approved by the Society of Surgical Oncology Executive Council, March 2007. Ann Surg Oncol. 2007;14(9):2425–7.

    Article  PubMed  Google Scholar 

  20. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97(22):1652–62.

    Article  PubMed  CAS  Google Scholar 

  21. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371–88.

    Article  PubMed  CAS  Google Scholar 

  22. Visvanathan K, Chlebowski RT, Hurley P, et al. American Society of Clinical Oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction. J Clin Oncol. 2009;27(19):3235–8.

    Article  PubMed  CAS  Google Scholar 

  23. Garreau JR, Nelson J, Look R, et al. Risk counseling and management in patients with lobular carcinoma in situ. Am J Surg. 2005;189(5):610–4; discussion 614–5.

    Google Scholar 

  24. Metcalfe KA, Narod SA. Breast cancer risk perception among women who have undergone prophylactic bilateral mastectomy. J Natl Cancer Inst. 2002;94(20):1564–9.

    Article  PubMed  Google Scholar 

  25. Abbott A, Rueth N, Pappas-Varco S, Kuntz K, Kerr E, Tuttle T. Perceptions of contralateral breast cancer: an overestimation of risk. Ann Surg Oncol. 2011;18(11):3129–36.

    Article  PubMed  Google Scholar 

  26. de la Pena-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Prophylactic mastectomy: is it worth it? Aesthetic Plast Surg. 2012;36(1):140–8.

    Article  PubMed  Google Scholar 

  27. Isern AE, Tengrup I, Loman N, Olsson H, Ringberg A. Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg. 2008;61(10):1177–87.

    Article  PubMed  CAS  Google Scholar 

  28. Zion SM, Slezak JM, Sellers TA, et al. Reoperations after prophylactic mastectomy with or without implant reconstruction. Cancer. 2003;98(10):2152–60.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Pamela R. Portschy MD, Rumbidzayi Nzara BA & Todd M. Tuttle MD, MS

  2. Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA

    Schelomo Marmor MPH & Beth A. Virnig PhD

Authors
  1. Pamela R. Portschy MD
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  2. Schelomo Marmor MPH
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  3. Rumbidzayi Nzara BA
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  4. Beth A. Virnig PhD
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  5. Todd M. Tuttle MD, MS
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Corresponding author

Correspondence to Todd M. Tuttle MD, MS.

Appendix: Cohort Selection

Appendix: Cohort Selection

Excluded Surgery Codes

  • 19: Local Tumor Destruction, NOS

  • 60–62, 64–69, 73–74: Radical Mastectomy, NOS

  • 70–72: Extended Radical Mastectomy

  • 90: Surgery, NOS

  • 99: Unknown if surgery performed

Included Surgery Codes

  • 0: No surgery

  • 20–24: Partial Mastectomy

  • 30: Subcutaneous Mastectomy

  • 40–49, 75: Total (Simple) Mastectomy

  • 80: Mastectomy, NOS

  • 50–59, 63: Modified Radical Mastectomy

Included Radiation Codes

  • 1: Beam radiation

  • 5: Radiation, NOS

Positive Lymph Nodes Examined Codes

  • 00: All nodes examined are negative

  • 98: No nodes were examined

  • 99: Unknown whether nodes are positive; not applicable; not stated in patient record

Stepwise Ascertainment of Final Pool of Patients

  • Start: female LCIS cases diagnoses 2000–2009 (code 8520): 59,275

  • After excluding cases younger than 18 and older than 80 at diagnosis: 52,999

  • After excluding cases diagnosed in a nursing home, by autopsy, or on death certificate: 52,989

  • After excluding cases localized, regional, distant and unstaged cases: 14,380

  • After excluding cases without microscopic confirmation by surgical code (see above codes): 14,048

  • After excluding cases from registries with less than five hundred LCIS cases: 11,641

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Portschy, P.R., Marmor, S., Nzara, R. et al. Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis. Ann Surg Oncol 20, 3240–3246 (2013). https://doi.org/10.1245/s10434-013-3121-4

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  • DOI: https://doi.org/10.1245/s10434-013-3121-4

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