Multidisciplinary Shared Decision Making in the Management of Ductal Carcinoma In Situ of the Breast

Priya Parikh, Barbara A Pockaj, Nabil Wasif, Michele Halyard, William Wong, Heidi E. Kosiorek, Amylou Dueck, Richard Gray

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Controversy continues regarding the use of adjuvant radiation therapy (RT) and hormonal therapy (HT) for patients undergoing breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS).Methods: A prospective database was queried to identify women 18 years of age or older treated for DCIS from 2002 to 2013. Results: BCT was completed for 300 patients with a median age of 66 years. The median DCIS size was 0.7 cm (range 0.1–6.0 cm). The DCIS grades were high (44 %), intermediate (37 %), and low (19 %). The closest margin was wider than 3 mm in 80 % and wider than 5 mm in 63 % of the cases. Adjuvant RT was administered to 183 patients (61 %), and the RT status of 9 patients (3 %) was unknown. RT was associated with age, DCIS size, comedo necrosis, grade, and treatment in 2002–2007 versus 2008–2013. Adjuvant HT was administered to 86 estrogen receptor-positive patients (39 %), and the HT status of 4 patients (2 %) was unknown. The median follow-up period was 63 months (range 4–151 months). The 5-year overall local recurrence (LR) rate was 4 % (95 % confidence interval [CI] 2.1–7.4 %). The 5-year LR rate was 3.9 % (95 % CI 1.8–8.6 %) for the RT patients and 4.1 % (95 % CI 1.6–10.7 %) for the patients not receiving RT. Of 13 LRs, 10 (77 %) were DCIS, and 3 (23 %) were invasive including one node-positive recurrence. Conclusions: Multidisciplinary and joint decision making in the treatment of DCIS results in a substantial and increasing number of patients forgoing adjuvant RT, adjuvant HT, or both. Reasonable 5-year LR rates suggest that such decision making can appropriately allocate patients to adjuvant therapies.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - May 19 2015

Fingerprint

Carcinoma, Intraductal, Noninfiltrating
Decision Making
Breast
Radiotherapy
Recurrence
Therapeutics
Confidence Intervals
Estrogen Receptors
Necrosis
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Multidisciplinary Shared Decision Making in the Management of Ductal Carcinoma In Situ of the Breast. / Parikh, Priya; Pockaj, Barbara A; Wasif, Nabil; Halyard, Michele; Wong, William; Kosiorek, Heidi E.; Dueck, Amylou; Gray, Richard.

In: Annals of Surgical Oncology, 19.05.2015.

Research output: Contribution to journalArticle

@article{2557927de9bb42ba99e9f0d44cbe7915,
title = "Multidisciplinary Shared Decision Making in the Management of Ductal Carcinoma In Situ of the Breast",
abstract = "Background: Controversy continues regarding the use of adjuvant radiation therapy (RT) and hormonal therapy (HT) for patients undergoing breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS).Methods: A prospective database was queried to identify women 18 years of age or older treated for DCIS from 2002 to 2013. Results: BCT was completed for 300 patients with a median age of 66 years. The median DCIS size was 0.7 cm (range 0.1–6.0 cm). The DCIS grades were high (44 {\%}), intermediate (37 {\%}), and low (19 {\%}). The closest margin was wider than 3 mm in 80 {\%} and wider than 5 mm in 63 {\%} of the cases. Adjuvant RT was administered to 183 patients (61 {\%}), and the RT status of 9 patients (3 {\%}) was unknown. RT was associated with age, DCIS size, comedo necrosis, grade, and treatment in 2002–2007 versus 2008–2013. Adjuvant HT was administered to 86 estrogen receptor-positive patients (39 {\%}), and the HT status of 4 patients (2 {\%}) was unknown. The median follow-up period was 63 months (range 4–151 months). The 5-year overall local recurrence (LR) rate was 4 {\%} (95 {\%} confidence interval [CI] 2.1–7.4 {\%}). The 5-year LR rate was 3.9 {\%} (95 {\%} CI 1.8–8.6 {\%}) for the RT patients and 4.1 {\%} (95 {\%} CI 1.6–10.7 {\%}) for the patients not receiving RT. Of 13 LRs, 10 (77 {\%}) were DCIS, and 3 (23 {\%}) were invasive including one node-positive recurrence. Conclusions: Multidisciplinary and joint decision making in the treatment of DCIS results in a substantial and increasing number of patients forgoing adjuvant RT, adjuvant HT, or both. Reasonable 5-year LR rates suggest that such decision making can appropriately allocate patients to adjuvant therapies.",
author = "Priya Parikh and Pockaj, {Barbara A} and Nabil Wasif and Michele Halyard and William Wong and Kosiorek, {Heidi E.} and Amylou Dueck and Richard Gray",
year = "2015",
month = "5",
day = "19",
doi = "10.1245/s10434-015-4607-z",
language = "English (US)",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - Multidisciplinary Shared Decision Making in the Management of Ductal Carcinoma In Situ of the Breast

AU - Parikh, Priya

AU - Pockaj, Barbara A

AU - Wasif, Nabil

AU - Halyard, Michele

AU - Wong, William

AU - Kosiorek, Heidi E.

AU - Dueck, Amylou

AU - Gray, Richard

PY - 2015/5/19

Y1 - 2015/5/19

N2 - Background: Controversy continues regarding the use of adjuvant radiation therapy (RT) and hormonal therapy (HT) for patients undergoing breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS).Methods: A prospective database was queried to identify women 18 years of age or older treated for DCIS from 2002 to 2013. Results: BCT was completed for 300 patients with a median age of 66 years. The median DCIS size was 0.7 cm (range 0.1–6.0 cm). The DCIS grades were high (44 %), intermediate (37 %), and low (19 %). The closest margin was wider than 3 mm in 80 % and wider than 5 mm in 63 % of the cases. Adjuvant RT was administered to 183 patients (61 %), and the RT status of 9 patients (3 %) was unknown. RT was associated with age, DCIS size, comedo necrosis, grade, and treatment in 2002–2007 versus 2008–2013. Adjuvant HT was administered to 86 estrogen receptor-positive patients (39 %), and the HT status of 4 patients (2 %) was unknown. The median follow-up period was 63 months (range 4–151 months). The 5-year overall local recurrence (LR) rate was 4 % (95 % confidence interval [CI] 2.1–7.4 %). The 5-year LR rate was 3.9 % (95 % CI 1.8–8.6 %) for the RT patients and 4.1 % (95 % CI 1.6–10.7 %) for the patients not receiving RT. Of 13 LRs, 10 (77 %) were DCIS, and 3 (23 %) were invasive including one node-positive recurrence. Conclusions: Multidisciplinary and joint decision making in the treatment of DCIS results in a substantial and increasing number of patients forgoing adjuvant RT, adjuvant HT, or both. Reasonable 5-year LR rates suggest that such decision making can appropriately allocate patients to adjuvant therapies.

AB - Background: Controversy continues regarding the use of adjuvant radiation therapy (RT) and hormonal therapy (HT) for patients undergoing breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS).Methods: A prospective database was queried to identify women 18 years of age or older treated for DCIS from 2002 to 2013. Results: BCT was completed for 300 patients with a median age of 66 years. The median DCIS size was 0.7 cm (range 0.1–6.0 cm). The DCIS grades were high (44 %), intermediate (37 %), and low (19 %). The closest margin was wider than 3 mm in 80 % and wider than 5 mm in 63 % of the cases. Adjuvant RT was administered to 183 patients (61 %), and the RT status of 9 patients (3 %) was unknown. RT was associated with age, DCIS size, comedo necrosis, grade, and treatment in 2002–2007 versus 2008–2013. Adjuvant HT was administered to 86 estrogen receptor-positive patients (39 %), and the HT status of 4 patients (2 %) was unknown. The median follow-up period was 63 months (range 4–151 months). The 5-year overall local recurrence (LR) rate was 4 % (95 % confidence interval [CI] 2.1–7.4 %). The 5-year LR rate was 3.9 % (95 % CI 1.8–8.6 %) for the RT patients and 4.1 % (95 % CI 1.6–10.7 %) for the patients not receiving RT. Of 13 LRs, 10 (77 %) were DCIS, and 3 (23 %) were invasive including one node-positive recurrence. Conclusions: Multidisciplinary and joint decision making in the treatment of DCIS results in a substantial and increasing number of patients forgoing adjuvant RT, adjuvant HT, or both. Reasonable 5-year LR rates suggest that such decision making can appropriately allocate patients to adjuvant therapies.

UR - http://www.scopus.com/inward/record.url?scp=84929698645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929698645&partnerID=8YFLogxK

U2 - 10.1245/s10434-015-4607-z

DO - 10.1245/s10434-015-4607-z

M3 - Article

C2 - 25986869

AN - SCOPUS:84952870891

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -