title: Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans.
abstract: Considerable debate exists about the optimal treatment of ductal carcinoma in situ (DCIS). Using electronic data sources, we examined first course treatment patterns among women aged 18 years and older diagnosed with DCIS between 2000-2010 from six Kaiser Permanente (KP) regions. We calculated the proportion of patients receiving breast conserving surgery (BCS), BCS plus radiation therapy, unilateral mastectomy, bilateral mastectomy, and hormone therapy. Multinomial logistic regression was used to assess the association between patient characteristics and treatment. We included 9,437 women: 1,086 (11.5%) African-American; 1,455 (15.4%) Asian; 918 (9.7%) Hispanic; and 5,978 (63.3%) non-Hispanic white. Most cases (42.2%) received BCS plus radiation as their initial treatment. Nearly equal numbers of women received BCS without radiation (28.5%) or unilateral mastectomy (24.6%). Use of bilateral mastectomy was uncommon (4.7%), and most women (72.2%) did not receive hormone therapy has part of their first course treatment. We observed statistically significant differences in treatment patterns for DCIS by KP region and patient age. Predictably, nuclear grade and the presence of comorbidities were associated with first course treatment for DCIS. We observed statistically significant increases in BCS plus radiation therapy and bilateral mastectomy over time. Although still uncommon, the frequency of bilateral mastectomy increased from 2.7% in 2000 to 7.0% in 2010. We also observed differences in treatment by race/ethnicity. Our findings help illustrate the complex nature of DCIS treatment in the United States, and highlight the need for evidence based guidelines for DCIS care.
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO USA.
authors.forename: Heather Spencer
authors.initials: HS
authors.lastname: Feigelson
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO USA.
authors.forename: Nikki M
authors.initials: NM
authors.lastname: Carroll
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
authors.affiliation: Kaiser Permanente Southern California, Pasadena, CA USA.
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.affiliation: Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD USA.
authors.forename: Chu-Ling
authors.initials: CL
authors.lastname: Yu
authors.affiliation: Kaiser Permanente Georgia, Atlanta, GA USA.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO USA.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Wrenn
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Capra
authors.affiliation: Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, CA USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA USA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
keywords: Breast cancer; Ductal carcinoma in situ; Mastectomy; Race; Treatment