title: The consequence of undertreatment of patients treated with breast conserving therapy for ductal carcinoma in-situ.
abstract: BACKGROUND
  The use of clinical features to allocate adjuvant therapy in the treatment of ductal carcinoma in situ with breast-conserving therapy remains controversial.
  
  
  METHODS
  A review of patients with ductal carcinoma in situ treated with breast-conserving therapy was performed. The recurrence rate was examined in relation to patient age, tumor characteristics, Van Nuys Prognostic Index, and the receipt of prescribed adjuvant therapies.
  
  
  RESULTS
  Six percent of patients (17 of 294) had developed local recurrences after a median follow-up period of 63 months. Fifty-nine percent of patients (91 of 154) with estrogen receptor-positive tumors did not receive prescribed tamoxifen. Thirty-one percent of patients (45 of 147) with Van Nuys Prognostic Index scores ≥7 did not receive recommended radiation therapy. Receipt of prescribed adjuvant therapy did not result in a decrease in the rate of local recurrence. Patient age was the only factor associated with local recurrence on univariate but not on multivariate analysis (P = .374).
  
  
  CONCLUSIONS
  A low rate of local recurrence was achieved despite a large number of patients' not receiving prescribed adjuvant therapies.
authors.affiliation: Comprehensive Breast Center, St Luke's-Roosevelt Hospital Center, New York, NY, USA. Electronic address: davilee@chpnet.org.
authors.forename: David Y
authors.initials: DY
authors.lastname: Lee
authors.forename: Jana L
authors.initials: JL
authors.lastname: Lewis
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Wexelman
authors.forename: Beth C
authors.initials: BC
authors.lastname: Freedman
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Ross
authors.forename: Paul I
authors.initials: PI
authors.lastname: Tartter
mesh_terms: D000367:Age Factors; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D002278:Carcinoma in Situ / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011960:Receptors, Estrogen; D013629:Tamoxifen
keywords: Adjuvant hormonal therapy; Adjuvant radiation therapy; DCIS; Ductal carcinoma in situ; Van Nuys Prognostic Index