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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 age group. Each treatment type is represented by a different colored bar, as indicated in the legend. 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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Fig2: First course therapy by age group. Each treatment type is represented by a different colored bar, as indicated in the legend. The “any hormone treatment” group is not mutually exclusive, as patients may also be represented in one of the surgical treatment groups.

Mentions: We also observed variation in treatment by age (Figure 2). For example, BCS with radiation therapy was the most common treatment among women under age 70 (range 40% - 47%) and BCS without radiation therapy was the most common treatment (40%) among women 70 years and older. Frequency of bilateral mastectomy decreased steadily with increasing age; 9% of women under 50 years received bilateral mastectomy, compared to only 1% of women aged 70 years or older. Frequency of unilateral mastectomy was relatively constant across age groups, and receipt of adjuvant hormone therapy was highest (35%) among women aged 50–59 years.Figure 2


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 age group. Each treatment type is represented by a different colored bar, as indicated in the legend. 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

Fig2: First course therapy by age group. Each treatment type is represented by a different colored bar, as indicated in the legend. The “any hormone treatment” group is not mutually exclusive, as patients may also be represented in one of the surgical treatment groups.
Mentions: We also observed variation in treatment by age (Figure 2). For example, BCS with radiation therapy was the most common treatment among women under age 70 (range 40% - 47%) and BCS without radiation therapy was the most common treatment (40%) among women 70 years and older. Frequency of bilateral mastectomy decreased steadily with increasing age; 9% of women under 50 years received bilateral mastectomy, compared to only 1% of women aged 70 years or older. Frequency of unilateral mastectomy was relatively constant across age groups, and receipt of adjuvant hormone therapy was highest (35%) among women aged 50–59 years.Figure 2

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