title: Patterns and correlates of local therapy for women with ductal carcinoma-in-situ.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Medicine and Health Management and Policy, University of Michigan, 300 N Ingalls, Ste 7E12, Box 0429, Ann Arbor, MI 48109-0429, USA. skatz@umich.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.forename: Lihua
authors.initials: L
authors.lastname: Liu
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Barbara
authors.initials: B
authors.lastname: Salem
authors.forename: Indu
authors.initials: I
authors.lastname: Lakhani
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data*