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Adjuvant Endocrine Therapy in Patients with Ductal Carcinoma In Situ: A Population-Based Retrospective Analysis from 2005 to 2012 in the National Cancer Data Base

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adjuvant endocrine therapy (AET) has been shown to reduce the risk of second breast cancer events in women with ductal carcinoma in situ (DCIS). There is no population-level evaluation of AET use in DCIS patients after standardized reporting of estrogen receptor (ER) status in cancer registries in 2004.

Methods

We conducted a retrospective cohort study of women with DCIS in the National Cancer Data Base between 2005 and 2012. Patient, tumor, and treatment characteristics as well as temporal trends associated with receipt of AET were evaluated by generalized linear regression.

Results

Among 206,255 DCIS patients, 36.5 % received AET. Fewer than half of ER-positive patients (n = 62,146, 46.4 %) received AET, with a modest but significant increase over time (43.6 % in 2005 to 47.5 % in 2012; unadjusted p trend <0.001). AET decreased among ER-negative patients (8.9–6.5 %, p trend <0.001) over the same time period. On multivariate analysis, younger (<40 years) and older (≥70 years) women were less likely to receive AET than 50- to 59-year-old women (<40 years: relative risk 0.86, 95 % confidence interval 0.82–0.89; ≥70 years: relative risk 0.79, 95 % confidence interval 0.77–0.81). ER-positive status conferred a 6.15-fold higher likelihood of receiving AET compared to ER-negative status (95 % confidence interval 5.81–6.50). Women who underwent breast-conserving surgery (BCS) with adjuvant radiotherapy were most likely to receive AET.

Conclusions

Receipt of AET is relatively low in the group of women most likely to benefit from its use, namely ER-positive patients who underwent BCS. Significant variation exists with respect to patient, tumor, site, and treatment factors. More tolerable drugs or clearer guideline recommendations may increase use.

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Acknowledgment

MRF was supported by a T32 grant support from the National Cancer Institute under award CA009168. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. National Institutes of Health. The data used in the study are derived from a deidentified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or for the conclusions drawn from these data by the investigators.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, Seattle, WA, USA

    Meghan R. Flanagan MD, MPH, Kristine E. Calhoun MD, Kenneth W. Gow MD & Sara H. Javid MD

  2. Department of Anatomic Pathology, University of Washington, Seattle, WA, USA

    Mara H. Rendi MD, PhD

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Vijayakrishna K. Gadi MD, PhD

  4. Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Vijayakrishna K. Gadi MD, PhD

  5. Seattle Children’s Hospital, Seattle, WA, USA

    Kenneth W. Gow MD

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  1. Meghan R. Flanagan MD, MPH
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  2. Mara H. Rendi MD, PhD
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  3. Vijayakrishna K. Gadi MD, PhD
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  6. Sara H. Javid MD
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Correspondence to Meghan R. Flanagan MD, MPH.

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Flanagan, M.R., Rendi, M.H., Gadi, V.K. et al. Adjuvant Endocrine Therapy in Patients with Ductal Carcinoma In Situ: A Population-Based Retrospective Analysis from 2005 to 2012 in the National Cancer Data Base. Ann Surg Oncol 22, 3264–3272 (2015). https://doi.org/10.1245/s10434-015-4668-z

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