title: Axillary evaluation and lymphedema in women with ductal carcinoma in situ.
abstract: Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65-90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 % of those treated with BCS and 69.4 % of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 % of women who had an axillary evaluation developed lymphedema, compared to 5.9 % of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 % CI 1.04-1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 % CI 0.40-1.74). Only 44 (0.40 %) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure.
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.
authors.forename: Ellie J
authors.initials: EJ
authors.lastname: Coromilas
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.
authors.forename: Yongmei
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Feldman
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Grace Clarke
authors.initials: GC
authors.lastname: Hillyer
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA. dlh23@columbia.edu.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. dlh23@columbia.edu.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D000072656:Breast Cancer Lymphedema / Q000453:epidemiology* / Q000209:etiology; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D009026:Mortality; D012189:Retrospective Studies; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D016019:Survival Analysis
keywords: Axillary evaluation; Ductal carcinoma in situ; Lymphedema