Potential Overtreatment of DCIS in Patients with Limited Life Expectancy.
Breast cancer
Ductal carcinoma in situ
Geriatrics
Life expectancy
Overtreatment
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
20 Jul 2024
20 Jul 2024
Historique:
received:
27
06
2024
accepted:
11
07
2024
medline:
20
7
2024
pubmed:
20
7
2024
entrez:
20
7
2024
Statut:
aheadofprint
Résumé
As the benefits of intensive locoregional therapy for ductal carcinoma in situ (DCIS) are realized over time in older adults, life expectancy may help to guide treatment decisions. We examined whether life expectancy was associated with extent of locoregional therapy in this population. Women ≥ 70 years old with < 5 cm of DCIS diagnosed 2010-2015 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset and categorized by a life expectancy ≤ 5 or > 5 years, defined by a validated claims-based measure. Differences in locoregional therapy (mastectomy + axillary surgery, mastectomy-only, lumpectomy + radiation therapy (RT) + axillary surgery, lumpectomy + RT, lumpectomy-only, and no treatment) by life expectancy were assessed using Pearson chi-squared tests. Generalized linear mixed models were used to identify factors associated with receipt of lumpectomy-only. Of 5346 women (median age of 75 years, range 70-97 years), 927 (17.3%) had a life expectancy ≤ 5 years. Of the 4041 patients who underwent lumpectomy, 710 (13.3%) underwent axillary surgery. More patients with life expectancy ≤ 5 years underwent lumpectomy-only (39.4% versus 27%), mastectomy-only (8.1% versus 5.3%), or no treatment (5.8% versus 3.2%; p < 0.001). On multivariable analysis, women with life expectancy ≤ 5 years had a significantly greater likelihood of undergoing lumpectomy-only [OR 1.90, 95% CI (1.63-2.22)]. Life expectancy is associated with lower-intensity locoregional therapy for older women with DCIS, yet a large proportion of patients with a life expectancy ≤ 5 years received RT and axillary surgery, highlighting potential overtreatment and opportunities to de-escalate locoregional therapy in older adults.
Identifiants
pubmed: 39031264
doi: 10.1245/s10434-024-15894-6
pii: 10.1245/s10434-024-15894-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Society of Surgical Oncology.
Références
Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1(7):888–96. https://doi.org/10.1001/jamaoncol.2015.2510 .
doi: 10.1001/jamaoncol.2015.2510
pubmed: 26291673
Worni M, Akushevich I, Greenup R, et al. Trends in treatment patterns and outcomes for ductal carcinoma in situ. J Natl Cancer Inst. 2015;107(12):djv263. https://doi.org/10.1093/jnci/djv263 .
doi: 10.1093/jnci/djv263
pubmed: 26424776
pmcid: 4707192
Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88. https://doi.org/10.1093/jnci/djr027 .
doi: 10.1093/jnci/djr027
pubmed: 21398619
pmcid: 3107729
Romero L, Klein L, Ye W, et al. Outcome after invasive recurrence in patients with ductal carcinoma in situ of the breast. Am J Surg. 2004;188(4):371–6. https://doi.org/10.1016/j.amjsurg.2004.06.034 .
doi: 10.1016/j.amjsurg.2004.06.034
pubmed: 15474428
Lee LA, Silverstein MJ, Chung CT, et al. Breast cancer-specific mortality after invasive local recurrence in patients with ductal carcinoma-in-situ of the breast. Am J Surg. 2006;192(4):416–9. https://doi.org/10.1016/j.amjsurg.2006.06.005 .
doi: 10.1016/j.amjsurg.2006.06.005
pubmed: 16978940
Sanders ME, Schuyler PA, Dupont WD, Page DL. The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer. 2005;103(12):2481–4. https://doi.org/10.1002/cncr.21069 .
doi: 10.1002/cncr.21069
pubmed: 15884091
Brennan ME, Turner RM, Ciatto S, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260(1):119–28. https://doi.org/10.1148/radiol.11102368 .
doi: 10.1148/radiol.11102368
pubmed: 21493791
Si J, Yang B, Guo R, et al. Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy. Cancer Biol Med. 2019;16(2):312–8. https://doi.org/10.20892/j.issn.2095-3941.2018.0159 .
doi: 10.20892/j.issn.2095-3941.2018.0159
pubmed: 31516751
pmcid: 6713631
Grimm LJ, Ryser MD, Partridge AH, et al. Surgical upstaging rates for vacuum assisted biopsy proven DCIS: implications for active surveillance trials. Ann Surg Oncol. 2017;24(12):3534–40. https://doi.org/10.1245/s10434-017-6018-9 .
doi: 10.1245/s10434-017-6018-9
pubmed: 28795370
pmcid: 6414216
Ryser MD, Weaver DL, Zhao F, et al. Cancer outcomes in DCIS patients without locoregional treatment. J Natl Cancer Inst. 2019;111(9):952–60. https://doi.org/10.1093/jnci/djy220 .
doi: 10.1093/jnci/djy220
pubmed: 30759222
pmcid: 6748726
Gradishar WJ, Moran MS, Abraham J, et al. NCCN Guidelines(R) insights: breast cancer, version 4.2023. J Natl Compr Canc Netw. 2023;21(6):594–608. https://doi.org/10.6004/jnccn.2023.0031 .
doi: 10.6004/jnccn.2023.0031
pubmed: 37308117
Akushevich I, Yashkin AP, Greenup RA, Hwang ES. A medicare-based comparative mortality analysis of active surveillance in older women with DCIS. NPJ Breast Cancer. 2020;6:57. https://doi.org/10.1038/s41523-020-00199-0 .
doi: 10.1038/s41523-020-00199-0
pubmed: 33145400
pmcid: 7599206
Youngwirth LM, Boughey JC, Hwang ES. Surgery versus monitoring and endocrine therapy for low-risk DCIS: The COMET Trial. Bull Am Coll Surg. 2017;102(1):62–3.
pubmed: 28925613
Elshof LE, Tryfonidis K, Slaets L, et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ - The LORD study. Eur J Cancer. 2015;51(12):1497–510. https://doi.org/10.1016/j.ejca.2015.05.008 .
doi: 10.1016/j.ejca.2015.05.008
pubmed: 26025767
Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer. 2015;51(16):2296–303. https://doi.org/10.1016/j.ejca.2015.07.017 .
doi: 10.1016/j.ejca.2015.07.017
pubmed: 26296293
Tang V, Zhao S, Boscardin J, et al. Functional status and survival after breast cancer surgery in nursing home residents. JAMA Surg. 2018;153(12):1090–6. https://doi.org/10.1001/jamasurg.2018.2736 .
doi: 10.1001/jamasurg.2018.2736
pubmed: 30167636
pmcid: 6433538
Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. Association of surgery with frailty status in older women with early-stage breast cancer. JAMA Surg. 2023;158(6):664–6. https://doi.org/10.1001/jamasurg.2022.8146 .
doi: 10.1001/jamasurg.2022.8146
pubmed: 36920410
pmcid: 10018401
Biganzoli L, Battisti NML, Wildiers H, et al. Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG). Lancet Oncol. 2021;22(7):e327–40. https://doi.org/10.1016/S1470-2045(20)30741-5 .
doi: 10.1016/S1470-2045(20)30741-5
pubmed: 34000244
Institute NC. Surveillance Epidemiology and End Results (SEER). Accessed April 19, 2024. http://seer.cancer.gov/
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27. https://doi.org/10.1097/00005650-199801000-00004 .
doi: 10.1097/00005650-199801000-00004
pubmed: 9431328
Tan A, Kuo YF, Goodwin JS. Predicting life expectancy for community-dwelling older adults from Medicare claims data. Am J Epidemiol. 2013;178(6):974–83. https://doi.org/10.1093/aje/kwt054 .
doi: 10.1093/aje/kwt054
pubmed: 23851579
pmcid: 3775541
Smith ME, Vitous CA, Hughes TM, Shubeck SP, Jagsi R, Dossett LA. Barriers and facilitators to de-implementation of the choosing wisely((R)) guidelines for low-value breast cancer surgery. Ann Surg Oncol. 2020;27(8):2653–63. https://doi.org/10.1245/s10434-020-08285-0 .
doi: 10.1245/s10434-020-08285-0
pubmed: 32124126
pmcid: 7338259
Herbach EL, Curran M, Roberson ML, et al. Guideline-concordant breast cancer care by patient race and ethnicity accounting for individual-, facility- and area-level characteristics: a SEER-Medicare study. Cancer Causes Control. Mar 28 2024; https://doi.org/10.1007/s10552-024-01859-3
Smith GL, Shih YC, Xu Y, et al. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. 2010;116(3):734–41. https://doi.org/10.1002/cncr.24741 .
doi: 10.1002/cncr.24741
pubmed: 20014181
Black DM, Jiang J, Kuerer HM, Buchholz TA, Smith BD. Racial disparities in adoption of axillary sentinel lymph node biopsy and lymphedema risk in women with breast cancer. JAMA Surg. 2014;149(8):788–96. https://doi.org/10.1001/jamasurg.2014.23 .
doi: 10.1001/jamasurg.2014.23
pubmed: 25073831
pmcid: 5853102
Minami CA, Jin G, Freedman RA, Schonberg MA, King TA, Mittendorf EA. Trends in locoregional therapy in older women with early-stage hormone receptor-positive breast cancer by frailty and life expectancy. Ann Surg Oncol. 2024;31(2):920–30. https://doi.org/10.1245/s10434-023-14446-8 .
doi: 10.1245/s10434-023-14446-8
pubmed: 37851196
Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102(3):170–8. https://doi.org/10.1093/jnci/djp482 .
doi: 10.1093/jnci/djp482
pubmed: 20071685
Silverstein MJ, Waisman JR, Gamagami P, et al. Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice Cancer. 1990;66(1):102–8. https://doi.org/10.1002/1097-0142(19900701)66:1%3c102::aid-cncr2820660119%3e3.0.co;2-5 .
doi: 10.1002/1097-0142(19900701)66:1<102::aid-cncr2820660119>3.0.co;2-5
pubmed: 2162238
Intra M, Veronesi P, Mazzarol G, et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg. 2003;138(3):309–13. https://doi.org/10.1001/archsurg.138.3.309 .
doi: 10.1001/archsurg.138.3.309
pubmed: 12611580
Intra M, Rotmensz N, Veronesi P, et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast: the experience of the European institute of oncology on 854 patients in 10 years. Ann Surg. 2008;247(2):315–9. https://doi.org/10.1097/SLA.0b013e31815b446b .
doi: 10.1097/SLA.0b013e31815b446b
pubmed: 18216539
Schwartz GF, Giuliano AE, Veronesi U, Consensus Conference C. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia. Pennsylvania Cancer. 2002;94(10):2542–51. https://doi.org/10.1002/cncr.10539 .
doi: 10.1002/cncr.10539
pubmed: 12173319
Coromilas EJ, Wright JD, Huang Y, et al. The influence of hospital and surgeon factors on the prevalence of axillary lymph node evaluation in ductal carcinoma in situ. JAMA Oncol. 2015;1(3):323–32. https://doi.org/10.1001/jamaoncol.2015.0389 .
doi: 10.1001/jamaoncol.2015.0389
pubmed: 26181180
Holm-Rasmussen EV, Jensen MB, Balslev E, Kroman N, Tvedskov TF. The use of sentinel lymph node biopsy in the treatment of breast ductal carcinoma in situ: a Danish population-based study. Eur J Cancer. 2017;87:1–9. https://doi.org/10.1016/j.ejca.2017.09.037 .
doi: 10.1016/j.ejca.2017.09.037
pubmed: 29096155
Van Zee KJ. Use of axillary staging in the management of ductal carcinoma in situ. JAMA Oncol. 2015;1(3):332–3. https://doi.org/10.1001/jamaoncol.2015.0390 .
doi: 10.1001/jamaoncol.2015.0390
pubmed: 26181181
Mott NM, Markovitz NH, Wang T, et al. Avoiding overtreatment of women >/=70 with early-stage breast cancer: a provider-level deimplementation strategy. J Surg Res. 2023;284:124–30. https://doi.org/10.1016/j.jss.2022.11.072 .
doi: 10.1016/j.jss.2022.11.072
pubmed: 36566589
Dossett LA, Mott NM, Bredbeck BC, et al. Using tailored messages to target overuse of low-value breast cancer care in older women. J Surg Res. 2022;270:503–12. https://doi.org/10.1016/j.jss.2021.10.005 .
doi: 10.1016/j.jss.2021.10.005
pubmed: 34801801
Jakub JW, Advani P, Maxwell R, Vallow L, Maimone S, McLaughlin S. SOUND (Sentinel Node Versus Observation After Axillary Ultrasound) trial: are we ready to change the tune of our breast cancer practice? Ann Surg Oncol. 2024;31(6):3672–4. https://doi.org/10.1245/s10434-024-15111-4 .
doi: 10.1245/s10434-024-15111-4
pubmed: 38418656
Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9(11):1557–64. https://doi.org/10.1001/jamaoncol.2023.3759 .
doi: 10.1001/jamaoncol.2023.3759
pubmed: 37733364
pmcid: 10514873
Early Breast Cancer Trialists’ Collaborative G, Correa C, McGale P, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;2010(41):162–77.
doi: 10.1093/jncimonographs/lgq039
McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709–15. https://doi.org/10.1200/JCO.2014.57.9029 .
doi: 10.1200/JCO.2014.57.9029
pubmed: 25605856
pmcid: 4334775