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Patterns and Correlates of Local Therapy for Women With Ductal Carcinoma-In-Situ

From the Departments of Internal Medicine, Health Management and Policy, and Health Behavior and Health Education, University of Michigan, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor; Department of Family Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, MI; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests to Steven J. Katz, MD, MPH, Departments of Medicine and Health Management and Policy, University of Michigan, 300 N Ingalls, Ste 7E12, Box 0429, Ann Arbor, MI 48109-0429; e-mail:skatz{at}umich.edu

PURPOSE: Concerns have been raised about the quality of treatment for women with ductal carcinoma-in-situ (DCIS) because persistent high rates of mastectomy suggest overtreatment, whereas lower than expected rates of radiation therapy after breast-conserving surgery (BCS) suggest undertreatment.

PATIENTS AND METHODS: All women with DCIS diagnosed in 2002 and who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries were identified and surveyed shortly after receipt of surgery (response rate, 79.7%; n = 817). Analyses were restricted to patients with DCIS (n = 659) indicated by SEER stage data.

RESULTS: Only 14.0% of patients at lowest risk of recurrence (based on tumor size and histologic grade) received a mastectomy compared with 22.8% and 52.6% of patients at intermediate and highest risk (P < .001). Only 13.1% of patients who were not influenced or slightly influenced by concerns about recurrence received mastectomy compared with 48.8% of women who were greatly influenced by this concern (P < .001). A between-geographic site difference in receipt of radiation after BCS was observed for the lowest risk group (38.9% in Los Angeles v 70.5% in Detroit) but not for the highest risk group (80.2% in Los Angeles v 85.9% in Detroit, P = .006 for site and risk group differences). Between-site differences in receipt of radiation after BCS were consistent with patient recall of surgeon discussions about treatment.

CONCLUSION: Surgeons are tailoring their recommendations for local therapy options for DCIS based on important clinical factors. Patient attitudes also play an important role in treatment decisions. The substantial influence of both surgeon opinion and patient attitudes should temper concerns about the quality of treatment for women with DCIS.

Supported by grant No. RO1 CA8837-A1 from the National Cancer Institute (Bethesda, MD) to the University of Michigan, and supported in part with Federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under contract Nos. N01-PC-35139 and NO1-PC-65064. The collection of cancer incidence data used in this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885.

The ideas and opinions expressed herein are those of the author, and no endorsement by the State of California, Department of Health Services is intended or should be inferred.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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