title: Local and national trends over a decade in the surgical treatment of ductal carcinoma in situ.
abstract: BACKGROUND
  Ductal cancer in situ (DCIS) is an increasingly frequent diagnosis in breast cancer, and management continues to challenge surgeons and oncologists. The purpose of our study was to examine local and national rates of breast conservation surgery and breast reconstruction surgery and to explore patient and surgeon factors associated with the procedures.
  
  
  METHODS
  Review of the 1,342 patients in our institutional breast cancer database yielded 211 patients with DCIS. The sample of 211 patients was compared with a national (Nationwide Inpatient Sample [NIS]) database. Patient and surgeon factors associated with the use of breast conservative surgery (BCS) and breast reconstruction (BR) postmastectomy were identified.
  
  
  RESULTS
  At our institution, the use of BCS steadily increased over ten years. Younger women with nonpalpable tumors, nonprivate insurance, and younger surgeons were more likely to have BCS. In 28 patients, breast reconstruction was performed: younger Caucasian women with private insurance and younger surgeons were more likely to undergo reconstruction. NIS data revealed that BCS was performed in 20% but that BCS did not increase over the 12-year period.
  
  
  CONCLUSIONS
  There was a steady increase in the use of BCS for DCIS at our institution, but a consistent, and much lower, use nationally. To increase breast conservation and reconstruction for DCIS, educational efforts should especially be directed toward elderly women and elderly surgeons.
authors.affiliation: Department of Surgery, Coastal Area Health Education Center, Wilmington, NC 28402-9025, USA. canuck@med.unc.edu
authors.forename: Cyrus
authors.initials: C
authors.lastname: Kotwall
authors.forename: Carla
authors.initials: C
authors.lastname: Brinker
authors.forename: Debra
authors.initials: D
authors.lastname: Covington
authors.forename: Tana
authors.initials: T
authors.lastname: Hall
authors.forename: Mary Sue
authors.initials: MS
authors.lastname: Hamann
authors.forename: J Gary
authors.initials: JG
authors.lastname: Maxwell
authors.forename: Anquonette
authors.initials: A
authors.lastname: Stiles
authors.forename: Anna
authors.initials: A
authors.lastname: Weiss
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000706:statistics & numerical data / Q000639:trends; D008408:Mastectomy / Q000706:statistics & numerical data / Q000639:trends; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009657:North Carolina; D014481:United States