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Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans.

Feigelson HS, Carroll NM, Weinmann S, Haque R, Yu CL, Butler MG, Waitzfelder B, Wrenn MG, Capra A, McGlynn EA, Habel LA - Springerplus (2015)

Bottom Line: 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.We also observed differences in treatment by race/ethnicity.

View Article: PubMed Central - PubMed

Affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO USA.

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.

No MeSH data available.


Related in: MedlinePlus

First course therapy by Kaiser Permanente region. Each region is represented by a different colored bar, as indicated in the legend; all regions combined shown on the right most bar for each type of treatment. P-values shown for chi-squared test for differences across regions. The “any hormone treatment” group is not mutually exclusive, as patients may also be represented in one of the surgical treatment groups.
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Fig1: First course therapy by Kaiser Permanente region. Each region is represented by a different colored bar, as indicated in the legend; all regions combined shown on the right most bar for each type of treatment. P-values shown for chi-squared test for differences across regions. The “any hormone treatment” group is not mutually exclusive, as patients may also be represented in one of the surgical treatment groups.

Mentions: We observed regional variation for receipt of BCS, BCS plus radiation, and bilateral mastectomy as first course therapy for DCIS (Figure 1). The fraction of BCS without radiation therapy ranged between 13-34% (p < 0.001), and BCS plus radiation therapy ranged between 36-59% (p < 0.001). Bilateral mastectomy was rare at all sites, and ranged between <1 - 8% (p < 0.001). We did not observe statistically significant variation by region for unilateral mastectomy (p = 0.14) or hormone therapy (p = 0.06) across regions.Figure 1


Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans.

Feigelson HS, Carroll NM, Weinmann S, Haque R, Yu CL, Butler MG, Waitzfelder B, Wrenn MG, Capra A, McGlynn EA, Habel LA - Springerplus (2015)

First course therapy by Kaiser Permanente region. Each region is represented by a different colored bar, as indicated in the legend; all regions combined shown on the right most bar for each type of treatment. P-values shown for chi-squared test for differences across regions. The “any hormone treatment” group is not mutually exclusive, as patients may also be represented in one of the surgical treatment groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300310&req=5

Fig1: First course therapy by Kaiser Permanente region. Each region is represented by a different colored bar, as indicated in the legend; all regions combined shown on the right most bar for each type of treatment. P-values shown for chi-squared test for differences across regions. The “any hormone treatment” group is not mutually exclusive, as patients may also be represented in one of the surgical treatment groups.
Mentions: We observed regional variation for receipt of BCS, BCS plus radiation, and bilateral mastectomy as first course therapy for DCIS (Figure 1). The fraction of BCS without radiation therapy ranged between 13-34% (p < 0.001), and BCS plus radiation therapy ranged between 36-59% (p < 0.001). Bilateral mastectomy was rare at all sites, and ranged between <1 - 8% (p < 0.001). We did not observe statistically significant variation by region for unilateral mastectomy (p = 0.14) or hormone therapy (p = 0.06) across regions.Figure 1

Bottom Line: 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.We also observed differences in treatment by race/ethnicity.

View Article: PubMed Central - PubMed

Affiliation: Institute for Health Research, Kaiser Permanente, Denver, CO USA.

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.

No MeSH data available.


Related in: MedlinePlus