TREATMENT TRENDS FOR DUCTAL CARCINOMA IN-SITU OF THE BREAST

Background: As a result of clinical trial publications, breast conserv ation treatment has been increasingly used for invasive breast cancer, The patterns of care for ductal carcinoma in situ (DCIS) were analyze d for the years 1985, 1986, 1988, 1990, and 1991 to determine whether the same treatment principles had been applied to patients with noninv asive disease. Methods: Data submitted on 20,556 patients with DCIS du ring the 5 study years were analyzed with regard to basic demographics and treatment trends. Results: Breast-conserving surgery for DCIS inc reased from 20.9% in 1985 to 35.4% in 1991. Modified radical mastectom y remained constant at 42%, Axillary node surgery increased from 52% i n 1985 to 58.5% in 1991. The use of radiation therapy for patients wit h partial mastectomy and no lymph node dissection ranges from 24.2% in 1990 to 37.7% in 1985, with 31.1% receiving radiation therapy in 1991 . Patients undergoing lymph node dissection with partial mastectomy we re more than twice as likely to receive postoperative radiation therap y than were patients without lymph node dissection. Conclusions: Modif ied radical mastectomy remains the most common surgical procedure, des pite the eligibility of many women for breast conservation treatment, As of 1991 the majority of women were still undergoing axillary lymph node surgery despite a node positivity rate of similar to 1%. Radiatio n therapy is significantly underused in patients with partial mastecto my, especially when no nodes were removed. Clinical trial results and professional education for DCIS treatment should change these trends.