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Ductal Carcinoma in Situ in Young Women: Increasing Rates of Mastectomy and Variability in Endocrine Therapy Use

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

Abstract

Background

Young women with ductal carcinoma in situ (DCIS) represent a unique cohort given considerations for future risk reduction and treatment effects on fertility and quality of life. We evaluated national patterns of care in the treatment of young women and the impact of those treatments on overall survival (OS).

Methods

Women younger than 50 years of age diagnosed with pure DCIS from 2004 to 2016 in the National Cancer Database (NCDB) were identified. Clinical, demographic, and choice of local therapy are summarized and trended over time. OS was analyzed using Cox proportional hazard models.

Results

A total of 52,150 women were identified, and the most common surgical treatment was breast-conservation surgery (BCS; 59%). Bilateral mastectomy (BM) increased in frequency from 2004 to 2016 (11–27%; p < 0.001). In women < 40 years of age, BM (39%) surpassed BCS (35%) in 2010 with a continued upward trend. On multivariable analysis, no OS benefit of BM (hazard ratio [HR] 0.99, p = 0.90) or unilateral mastectomy (UM; HR 0.98, p = 0.80) was observed when compared with BCS + radiation therapy (RT). Inferior OS was seen with BCS, Black race, estrogen receptor (ER)-negative, and tumor ≥ 2.5 cm (p ≤ 0.006). In ER+ patients, there was a significant difference in endocrine therapy (ET) use between BM (11%), UM (33%), and BCS (28%) compared with BCS + RT (64%, p < 0.001).

Conclusion

The use of BM for DCIS is increasing in younger patients and now exceeds breast-conservation approaches in women < 40 years of age with no evidence of improved OS. Among ER+ patients, the rates of ET are lower in the BM, UM, and BCS-alone groups compared with BCS + RT.

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Acknowledgments

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Funding

No grants or other financial support were used for this study.

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Authors and Affiliations

  1. Department of Radiation Oncology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, USA

    David J. Byun MD & Naamit K. Gerber MD

  2. Department of Radiation Oncology, Holy Name Medical Center, Teaneck, NJ, USA

    S. Peter Wu MD

  3. Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA

    Himanshu Nagar MD

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  1. David J. Byun MD
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  2. S. Peter Wu MD
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  4. Naamit K. Gerber MD
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Correspondence to Naamit K. Gerber MD.

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David J. Byun, S. Peter Wu, Himanshu Nagar and Naamit K. Gerber have no actual or potential conflicts of interest to declare.

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Byun, D.J., Wu, S.P., Nagar, H. et al. Ductal Carcinoma in Situ in Young Women: Increasing Rates of Mastectomy and Variability in Endocrine Therapy Use. Ann Surg Oncol 28, 6083–6096 (2021). https://doi.org/10.1245/s10434-021-09972-2

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  • DOI: https://doi.org/10.1245/s10434-021-09972-2

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