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

• Published in: Breast (Edinburgh) Vol. 23; no. 1; pp. 63 - 68
• Main Authors: van Steenbergen, L.N, Voogd, A.C, Roukema, J.A, Louwman, W.J, Duijm, L.E.M, Coebergh, J.W.W, van de Poll-Franse, L.V
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2014
• Subjects: Aged; Axilla; Axillary staging; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - therapy; DCIS; Female; Guideline Adherence; Hematology, Oncology and Palliative Medicine; Hospitals - statistics & numerical data; Humans; Logistic Models; Lymph Node Excision - statistics & numerical data; Lymph Node Excision - trends; Lymph Nodes - pathology; Mastectomy - statistics & numerical data; Mastectomy - trends; Mastectomy, Segmental - statistics & numerical data; Mastectomy, Segmental - trends; Middle Aged; Multivariate Analysis; Neoplasm Staging - statistics & numerical data; Neoplasm Staging - trends; Netherlands; Practice Guidelines as Topic; Radiotherapy, Adjuvant - statistics & numerical data; Radiotherapy, Adjuvant - trends; Screening; Sentinel Lymph Node Biopsy - statistics & numerical data; Sentinel Lymph Node Biopsy - trends; Treatment; Variation; Netherlands; Screening; Axillary staging; Treatment; Variation; DCIS
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2013.11.001

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. Conclusion 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.