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Annals of Oncology 13:1236-1245, 2002
© 2002 European Society for Medical Oncology

Original Paper

Management of women with ductal carcinoma in situ of the breast: a population-based study

H. M. Verkooijen1, G. Fioretta1, C. de Wolf1, G. Vlastos2, J. Kurtz3, B. Borisch4, P. Schäfer2, A. Spiliopoulos5, A. P. Sappino6, R. Renella1, B. Pittet7, J. Schmid de Gruneck8, Y. Wespi9, I. Neyroud-Caspar1 and C. Bouchardy1,+

1 Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva; 2 Department of Gynecology, 3 Division of Radio-Oncology, 4 Division of Clinical Pathology, 5 Unit of Thoracic Surgery, 6 Division of Oncology and 7 Unit of Plastic and Reconstructive Surgery, Geneva University Hospitals; 8 Ligue Genevoise contre le Cancer, Geneva; 9 Gynecologist, Associations des Médecins du Canton de Genève, Geneva, Switzerland

Received 12 October 2001; revised 17 January 2002; accepted 11 February 2002

Background:

Increasing incidence of ductal carcinoma in situ (DCIS) confronts patients and clinicians with optimal treatment decisions. This multidisciplinary study investigates therapeutic modalities of DCIS in daily practice and provides recommendations on how to increase quality of care.

Patients and methods:

All women (n = 116) with unilateral DCIS recorded in the Geneva Cancer Registry from 1995 to 1999 were considered. Information concerned patient and tumor characteristics, treatment and outcome. Factors linked to therapy were determined using a case–control approach. Cases were women with treatment of interest and controls other women on the study.

Results:

Most DCIS cases (62%) were discovered by mammography screening. Ninety (78%) women had breast-conserving surgery (BCS), 18 (16%) mastectomy and seven (6%) bilateral mastectomy. Eight (7%) patients had tumor-positive margins, 18 (16%) lymph node dissection and two (1.7%) chemotherapy. Twenty-five per cent of women with BCS had no radiotherapy, three had radiotherapy after mastectomy. Less than 50% underwent breast reconstruction after mastectomy. Method of discovery, multifocality, tumor localization, size and differentiation were linked to the use of BCS or lymph node dissection.

Conclusions:

Because of important disparities in DCIS management, recommendations are made to increase quality of care, in particular to prevent axillary dissection or bilateral mastectomy and to increase the use of radiotherapy after BCS.

Key words: breast, breast-conserving therapy, cancer registry, ductal carcinoma in situ, lymph node dissection, therapy


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