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Factors Influencing Use of Hormone Therapy for Ductal Carcinoma In Situ: A National Cancer Database Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adjuvant hormonal therapy (HT) reduces breast cancer recurrence risk in estrogen receptor-positive (ER+) ductal carcinoma in situ (DCIS). We assessed national practice patterns and influence of surgery and pathology on HT use in DCIS.

Methods

Data on DCIS patients diagnosed from 2004 to 2014 were extracted from the National Cancer Database, and patients were classified according to ER status and whether HT was received. Factors associated with HT use were assessed using Chi square tests for univariate analysis and logistic regression for multivariate analysis.

Results

Overall, 207,738 patients were evaluable as follows: ER+ (69.3%), ER− (13.7%), and ER unknown (17.0%). Among ER+ DCIS patients, 46.5% received HT, and HT use increased over time (42.3% in 2004 to 50.6% in 2014; p < 0.001). In contrast, 7.8% of ER− DCIS patients received HT, decreasing from 10.7% in 2004 to 5.9% in 2014 (p < 0.001). HT use varied by surgery type (BCS, 53.9%; unilateral mastectomy, 31.5%; and bilateral mastectomy, 8.1%; p < 0.001) and use was higher in BCS patients receiving adjuvant radiation than those not receiving radiation (62.7 vs. 29.1%; p < 0.001). Males treated with BCS were less likely to receive HT than females (43.2 vs. 54.0%; p < 0.001). In the BCS subset, higher use of HT was associated with more recent calendar year, age between 40 and 80 years, female sex, positive progesterone receptor status, and radiation use.

Conclusion

Adjuvant HT use in ER+ DCIS has increased over time, with the highest rates in patients treated with BCS and radiation. While inappropriate HT use was observed in ER− and bilateral mastectomy patients, the frequency of use in these categories decreased over time.

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Acknowledgment

The NCDB is a joint project of the CoC of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and its participating hospitals are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosures

Toan T. Nguyen, Tanya L. Hoskin, Courtney N. Day, Elizabeth B. Habermann, Matthew P. Goetz, and Judy C. Boughey have no disclosures to declare.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Toan T. Nguyen MD, Elizabeth B. Habermann PhD & Judy C. Boughey MD

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Tanya L. Hoskin MS & Courtney N. Day BS

  3. The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann PhD

  4. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Matthew P. Goetz MD

Authors
  1. Toan T. Nguyen MD
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  2. Tanya L. Hoskin MS
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  3. Courtney N. Day BS
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  4. Elizabeth B. Habermann PhD
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  5. Matthew P. Goetz MD
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  6. Judy C. Boughey MD
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Corresponding author

Correspondence to Judy C. Boughey MD.

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Nguyen, T.T., Hoskin, T.L., Day, C.N. et al. Factors Influencing Use of Hormone Therapy for Ductal Carcinoma In Situ: A National Cancer Database Study. Ann Surg Oncol 24, 2989–2998 (2017). https://doi.org/10.1245/s10434-017-5930-3

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  • DOI: https://doi.org/10.1245/s10434-017-5930-3

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