title: Time trends and inter-hospital variation in treatment and axillary staging of patients with ductal carcinoma in situ of the breast in the era of screening in Southern Netherlands.
abstract: BACKGROUND
  To examine variation in time and place in axillary staging and treatment of patients with ductal carcinoma in situ (DCIS) of the breast.
  
  
  METHODS
  Trends in patients with DCIS recorded in the Eindhoven Cancer Registry diagnosed in 1991-2010 (n = 2449) were examined.
  
  
  RESULTS
  The use of breast conserving surgery (BCS) went from 17% to 67% in 1991-2010 and administration of radiotherapy after BCS increased to 89%. Axillary lymph node dissection decreased to almost 0%, while sentinel node biopsy was performed in 65% of patients in 2010. The proportion who underwent BCS varied between hospitals from 49% to 80%; the proportion without axillary staging ranged from 21% to 60%. Patients with screen-detected DCIS were more likely to receive BCS.
  
  
  CONCLUSIONS
  There was considerable variation in the use of BCS, radiotherapy, and axillary staging of DCIS over time and between hospitals. Patients with DCIS were more likely to be treated with BCS if their disease was detected by screening.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands. Electronic address: research@ikz.nl.
authors.forename: L N
authors.initials: LN
authors.lastname: van Steenbergen
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Surgery, St. Elisabeth Hospital Tilburg, PO Box 90151, 5000 LC Tilburg, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Roukema
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Louwman
authors.affiliation: Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands.
authors.forename: L E M
authors.initials: LE
authors.lastname: Duijm
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands.
authors.forename: L V
authors.initials: LV
authors.lastname: van de Poll-Franse
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000706:statistics & numerical data / Q000639:trends*; D008198:Lymph Nodes / Q000473:pathology; D008408:Mastectomy / Q000706:statistics & numerical data / Q000639:trends; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000706:statistics & numerical data / Q000639:trends; D009426:Netherlands; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends*; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data / Q000639:trends
keywords: Axillary staging; DCIS; Screening; Treatment; Variation