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.
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.
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 %.
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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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