NATIONAL TREATMENT TRENDS FOR DUCTAL CARCINOMA IN-SITU OF THE BREAST

Objective: To evaluate the national treatment trends for the managemen t of ductal carcinoma in situ as related to the individual characteris tics of patients and to the reporting of demographics. Design: Nationa l Cancer Data Base review. Patients: Patients (N=39 010) who were diag nosed as having ductal carcinoma in situ between 1985 and 1993. Main O utcome Measures: Treatment principles, including the use of breast-pre serving surgery, axillary lymph node dissection, and radiotherapy, as related to the following variables: age, income level, and ethnicity o f the patient; the tumor size, grade, and anatomical subsite; year of diagnosis; geographic location of treatment; and hospital type and cas eload. Results: During the 8 years of analysis, the use of breast pres ervation therapy increased from 31% to 54%. Treatment selection varied to some degree with each of the variables examined. Tumors with favor able sizes and grades were associated with increased rates of breast p reservation and lower rates of axillary lymph node dissection and radi otherapy utilization. Overall, only 45% of the patients who were treat ed with breast preservation received adjuvant radiotherapy. However, d uring this study, radiotherapy utilization increased from 38% to 54%. Axillary lymph node dissection was performed in 49% of the patients wi th a 12% reduction in use over time. Conclusions: Breast-preserving su rgery now accounts for more than half of all cases of ductal carcinoma in situ followed by the National Cancer Data Base. However, there sti ll remains an inappropriately high rate of axillary lymph node dissect ion and a low rate of radiotherapy utilization. Clinical trial results and professional education should continue to optimize the management of patients with ductal carcinoma in situ.