title: Multidisciplinary Shared Decision Making in the Management of Ductal Carcinoma In Situ of the Breast.
abstract: BACKGROUND
  Controversy continues regarding the use of adjuvant radiation therapy (RT) and hormonal therapy (HT) for patients undergoing breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS).
  
  
  METHODS
  A prospective database was queried to identify women 18 years of age or older treated for DCIS from 2002 to 2013.
  
  
  RESULTS
  BCT was completed for 300 patients with a median age of 66 years. The median DCIS size was 0.7 cm (range 0.1-6.0 cm). The DCIS grades were high (44 %), intermediate (37 %), and low (19 %). The closest margin was wider than 3 mm in 80 % and wider than 5 mm in 63 % of the cases. Adjuvant RT was administered to 183 patients (61 %), and the RT status of 9 patients (3 %) was unknown. RT was associated with age, DCIS size, comedo necrosis, grade, and treatment in 2002-2007 versus 2008-2013. Adjuvant HT was administered to 86 estrogen receptor-positive patients (39 %), and the HT status of 4 patients (2 %) was unknown. The median follow-up period was 63 months (range 4-151 months). The 5-year overall local recurrence (LR) rate was 4 % (95 % confidence interval [CI] 2.1-7.4 %). The 5-year LR rate was 3.9 % (95 % CI 1.8-8.6 %) for the RT patients and 4.1 % (95 % CI 1.6-10.7 %) for the patients not receiving RT. Of 13 LRs, 10 (77 %) were DCIS, and 3 (23 %) were invasive including one node-positive recurrence.
  
  
  CONCLUSIONS
  Multidisciplinary and joint decision making in the treatment of DCIS results in a substantial and increasing number of patients forgoing adjuvant RT, adjuvant HT, or both. Reasonable 5-year LR rates suggest that such decision making can appropriately allocate patients to adjuvant therapies.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Parikh
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pockaj
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Halyard
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: William
authors.initials: W
authors.lastname: Wong
authors.affiliation: Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Kosiorek
authors.affiliation: Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Phoenix, AZ, USA. gray.richard@mayo.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011878:Radiotherapy; D015996:Survival Rate