title: Clinical presentation and surgical quality in treatment of ductal carcinoma in situ of the breast.
abstract: To assess quality of surgical treatment of ductal carcinoma in situ (DCIS) and to compare teaching and non-teaching hospitals that constitute the Comprehensive Cancer Centres of the Middle Netherlands (IKMN), we retrospectively reviewed 499 patients with 502 DCIS lesions treated in the period 1989-2002. In teaching hospitals fewer patients presented with clinical symptoms compared to non-teaching hospitals (15% versus 24.0%, p = 0.01). Finally, 65% of patients underwent breast-conserving surgery and 35% of patients a mastectomy (no significant differences between the two types of hospitals). In teaching hospitals 19% of the patients had a disease-involved or unknown surgical margins versus 13% in non-teaching hospitals (p = 0.04). Twenty patients (4%) received radiation therapy postoperatively with no differences between teaching and non-teaching hospitals (p = 0.98). Quality of surgical treatment is the most important prognostic factor in treatment of DCIS. The quality of excisions should be improved and the exact status of margins should be recorded in pathology reports.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands.
authors.forename: Arjan P
authors.initials: AP
authors.lastname: Schouten van der Velden
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Veronica C M
authors.initials: VC
authors.lastname: Koot
authors.forename: Adriaan
authors.initials: A
authors.lastname: Hennipman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome