A. C. Alapati1, T. A. James1 1Beth Israel Deaconess Medical Center,Surgery,Boston, MA, USA
Introduction: Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer. Current clinical trials are exploring active surveillance (AS) of DCIS. The purpose of this study is to characterize current practice trends in the use of AS. The findings may inform clinical trials and provide insight into factors influencing adoption into practice.
Methods: The National Cancer Database was used to identify women diagnosed with DCIS from 2004-2015. Management with AS was defined as any patient not undergoing surgery, chemotherapy or radiation therapy. Multivariable logistic regression was used to assess patterns of AS.
Results: Of 84,281 women with DCIS, 342 (0.4%) underwent AS. Increased age, (OR 1.16), Hispanic/non-Hispanic black ethnicities (OR 1.90; 1.54), treatment at an academic facility (OR 1.76), non-private insurance (OR 1.29), lower grade (OR 1.34), and lower volume facilities (OR 1.60) were associated with higher use of AS. Patients with one or more comorbidities less frequently underwent AS compared with patients without morbidities. (OR 0.70) Residence distance from the treatment center showed no significance. Of all patients undergoing AS, 10.5% received hormonal therapy.
Conclusion: AS is currently an infrequently used treatment modality for patients with DCIS. We observed variations in AS based on age, ethnicity, facility type, facility volume, insurance status and tumor grade. The vast majority of patients managed with AS did not receive hormone therapy. This information may further inform strategies for clinical trials, as well as quality of care in the management of DCIS.