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

L N van Steenbergen; A C Voogd; J A Roukema; W J Louwman; L E M Duijm; J W W Coebergh; L V van de Poll-Franse

doi:10.1016/j.breast.2013.11.001

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

Breast. 2014 Feb;23(1):63-8. doi: 10.1016/j.breast.2013.11.001. Epub 2013 Dec 2.

Authors

L N van Steenbergen¹, A C Voogd², J A Roukema³, W J Louwman⁴, L E M Duijm⁵, J W W Coebergh⁶, L V van de Poll-Franse⁷

Affiliations

¹ Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands. Electronic address: [email protected].
² Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
³ Department of Surgery, St. Elisabeth Hospital Tilburg, PO Box 90151, 5000 LC Tilburg, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands.
⁴ Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands.
⁵ Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands.
⁶ Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
⁷ Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands.

PMID: 24291376
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.

Keywords: Axillary staging; DCIS; Screening; Treatment; Variation.

MeSH terms

Aged
Axilla
Breast Neoplasms / pathology
Breast Neoplasms / therapy*
Carcinoma, Intraductal, Noninfiltrating / pathology
Carcinoma, Intraductal, Noninfiltrating / therapy*
Female
Guideline Adherence
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*
Sentinel Lymph Node Biopsy / statistics & numerical data
Sentinel Lymph Node Biopsy / trends