title: The management of ductal carcinoma in situ in North America and Europe. Results of a survey.
abstract: BACKGROUND
  The goal of the current study was to understand and document contemporary treatment approaches in the management of ductal carcinoma in situ (DCIS).
  
  
  METHODS
  An original questionnaire was designed to assess radiation oncologists' management of breast carcinoma, including 26 questions specifically addressing DCIS. A postal survey was conducted of members of the American and European Societies of Therapeutic Radiology and Oncology. The results of 702 responses from North America were compared with 435 responses from Europe, to determine treatment recommendations and variability by type of institution and geographic region.
  
  
  RESULTS
  There were strong correlations between the grade of DCIS and/or the margin status and the use of radiotherapy (RT; P < 0.0001). For Grade 3 DCIS, RT was recommended regardless of the margin status. Opinions were split in the treatment of low-grade DCIS with 10-mm margins. North American respondents were more likely to recommend RT for low-grade DCIS than their European counterparts (P < 0.0001). Within the United States, there were significant regional variations in physician recommendations for tamoxifen (P < 0.001), but not in the tendency to recommend RT. North American academic physicians were less likely to recommend RT for favorable DCIS than nonacademic physicians (P < 0.01).
  
  
  CONCLUSIONS
  There were marked differences in physician opinions regarding the management of DCIS, with significant international differences in patterns of care. The survey quantified and highlighted areas of agreement and controversy regarding the use of RT and tamoxifen in the management of DCIS. It provided support for large international trials to evaluate the optimal management of DCIS in the areas identified as most controversial.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ceilley
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.forename: Saveli
authors.initials: S
authors.lastname: Goldberg
authors.forename: Lisa
authors.initials: L
authors.lastname: Kachnic
authors.forename: Simon
authors.initials: S
authors.lastname: Powell
authors.forename: Alphonse
authors.initials: A
authors.lastname: Taghian
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D013629:Tamoxifen