National Breast Cancer Audit: ductal carcinoma in situ management in Australia and New Zealand.
BACKGROUND
Ductal carcinoma in situ (DCIS) is a significant issue in Australia and New Zealand with rising incidence because of the implementation of mammographic screening. Current information on its natural history is unable to accurately predict progression to invasive cancer. In 2003, the National Breast Cancer Centre in Australia published recommendations for DCIS. In Australia and New Zealand, the National Breast Cancer Audit collects information on DCIS cases. This article will examine these recommendations and provide information from the audit on current DCIS management.


METHODS
Three thousand six hundred and twenty-nine cases of DCIS were entered by 274 breast surgeons between January 1998 and December 2004. Data items in the National Breast Cancer Audit database that were covered in the National Breast Cancer Centre recommendations were reviewed. Information was available on the following: diagnostic biopsy rates for all cases and mammographically positive cases and rates of breast conserving surgery (BCS), clear margins following BCS, postoperative radiotherapy following BCS for groups at high risk of recurrence as well as axillary procedures and tamoxifen prescription.


RESULTS
Close adherence was found in diagnostic biopsy, BCS and clear margin rates. Some high-risk groups received radiotherapy, although women with 'close' margins did not in 33% of cases. Axillary procedures were conducted in 23% of cases and most (81%) patients were not prescribed tamoxifen.


CONCLUSIONS
There was predominantly close adherence to recommendations with three possible areas of improvement: fewer axillary procedures, an appraisal of radiotherapy practice following BCS and more investigation into tamoxifen prescription practices for DCIS.
Cuncins-Hearn
Astrid
A
National Breast Cancer Audit, ASERNIP-S, Royal Australasian College of Surgeons, Stepney, South Australia, Australia.
Boult
Margaret
M
Babidge
Wendy
W
Zorbas
Helen
H
Villanueva
Elmer
E
Evans
Alison
A
Oliver
David
D
Kollias
James
J
Reeve
Tom
T
Maddern
Guy
G
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D001365:Axilla; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008197:Lymph Node Excision; D008327:Mammography; D015412:Mastectomy, Segmental; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D013629:Tamoxifen / Q000627:therapeutic use
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen