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.
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.
Authors: B Fisher; J Dignam; N Wolmark; E Mamounas; J Costantino; W Poller; E R Fisher; D L Wickerham; M Deutsch; R Margolese; N Dimitrov; M Kavanah Journal: J Clin Oncol Date: 1998-02 Impact factor: 44.544
Authors: N Bijker; J L Peterse; L Duchateau; J P Julien; I S Fentiman; C Duval; S Di Palma; J Simony-Lafontaine; I de Mascarel; M J van de Vijver Journal: J Clin Oncol Date: 2001-04-15 Impact factor: 44.544
Authors: L L Kestin; N S Goldstein; A A Martinez; M Rebner; M Balasubramaniam; R C Frazier; J T Register; J Pettinga; F A Vicini Journal: Ann Surg Date: 2000-02 Impact factor: 12.969
Authors: B Fisher; J Costantino; C Redmond; E Fisher; R Margolese; N Dimitrov; N Wolmark; D L Wickerham; M Deutsch; L Ore Journal: N Engl J Med Date: 1993-06-03 Impact factor: 91.245
Authors: Monica Morrow; Eric A Strom; Lawrence W Bassett; D David Dershaw; Barbara Fowble; J a y R Harris; Frances O'Malley; Stuart J Schnitt; S Eva Singletary; David P Winchester Journal: CA Cancer J Clin Date: 2002 Sep-Oct Impact factor: 508.702
Authors: Ann H Partridge; Joann G Elmore; Debbie Saslow; Worta McCaskill-Stevens; Stuart J Schnitt Journal: CA Cancer J Clin Date: 2012-04-04 Impact factor: 508.702
Authors: Sarah T Hawley; Nancy K Janz; Sarah E Lillie; Christopher R Friese; Jennifer J Griggs; John J Graff; Ann S Hamilton; Sarika Jain; Steven J Katz Journal: Patient Educ Couns Date: 2010-11-12
Authors: Reshma Jagsi; Paul Abrahamse; Monica Morrow; Sarah T Hawley; Jennifer J Griggs; John J Graff; Ann S Hamilton; Steven J Katz Journal: J Clin Oncol Date: 2010-03-29 Impact factor: 44.544
Authors: Jennifer A Ligibel; Ann Partridge; Anita Giobbie-Hurder; Mehra Golshan; Karen Emmons; Eric P Winer Journal: Ann Surg Oncol Date: 2008-10-24 Impact factor: 5.344
Authors: Grace L Smith; Ya-Chen T Shih; Ying Xu; Sharon H Giordano; Benjamin D Smith; George H Perkins; Welela Tereffe; Wendy A Woodward; Thomas A Buchholz Journal: Cancer Date: 2010-02-01 Impact factor: 6.860
Authors: Caprice C Greenberg; Eric C Schneider; Stuart R Lipsitz; Clifford Y Ko; Jennifer L Malin; Arnold M Epstein; Jane C Weeks; Katherine L Kahn Journal: J Am Coll Surg Date: 2008-02-01 Impact factor: 6.113
Authors: Sarah T Hawley; Nancy K Janz; Ann Hamilton; Jennifer J Griggs; Amy K Alderman; Mahasin Mujahid; Steven J Katz Journal: Patient Educ Couns Date: 2008-11