Management of women with ductal carcinoma in situ of the breast: a population-based study.
BACKGROUND
Increasing incidence of ductal carcinoma in situ (DCIS) confronts patients and clinicians with optimal treatment decisions. This multidisciplinary study investigates therapeutic modalities of DCIS in daily practice and provides recommendations on how to increase quality of care.


METHODS
All women (n = 116) with unilateral DCIS recorded in the Geneva Cancer Registry from 1995 to 1999 were considered. Information concerned patient and tumor characteristics, treatment and outcome. Factors linked to therapy were determined using a case-control approach. Cases were women with treatment of interest and controls other women on the study.


RESULTS
Most DCIS cases (62%) were discovered by mammography screening. Ninety (78%) women had breast-conserving surgery (BCS), 18 (16%) mastectomy and seven (6%) bilateral mastectomy. Eight (7%) patients had tumor-positive margins, 18 (16%) lymph node dissection and two (1.7%) chemotherapy. Twenty-five per cent of women with BCS had no radiotherapy, three had radiotherapy after mastectomy. Less than 50% underwent breast reconstruction after mastectomy. Method of discovery, multifocality, tumor localization, size and differentiation were linked to the use of BCS or lymph node dissection.


CONCLUSIONS
Because of important disparities in DCIS management, recommendations are made to increase quality of care, in particular to prevent axillary dissection or bilateral mastectomy and to increase the use of radiotherapy after BCS.
Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, Geneva, Switzerland.
H M
HM
Verkooijen
G
G
Fioretta
C
C
De Wolf
G
G
Vlastos
J
J
Kurtz
B
B
Borisch
P
P
Schäfer
A
A
Spiliopoulos
A P
AP
Sappino
R
R
Renella
B
B
Pittet
J
J
Schmid De Gruneck
Y
Y
Wespi
I
I
Neyroud-Caspar
C
C
Bouchardy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000628:therapy*; D016022:Case-Control Studies; D002454:Cell Differentiation; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011159:Population Surveillance; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors