Local and national trends over a decade in the surgical treatment of ductal carcinoma in situ

Background Ductal cancer in situ (DCIS) is an increasingly frequent diagnosis in breast cancer, and management continues to challenge surgeons and oncologists. The purpose of our study was to examine local and national rates of breast conservation surgery and breast reconstruction surgery and to explore patient and surgeon factors associated with the procedures. Methods Review of the 1,342 patients in our institutional breast cancer database yielded 211 patients with DCIS. The sample of 211 patients was compared with a national (Nationwide Inpatient Sample [NIS]) database. Patient and surgeon factors associated with the use of breast conservative surgery (BCS) and breast reconstruction (BR) postmastectomy were identified. Results At our institution, the use of BCS steadily increased over ten years. Younger women with nonpalpable tumors, nonprivate insurance, and younger surgeons were more likely to have BCS. In 28 patients, breast reconstruction was performed: younger Caucasian women with private insurance and younger surgeons were more likely to undergo reconstruction. NIS data revealed that BCS was performed in 20% but that BCS did not increase over the 12-year period. Conclusions There was a steady increase in the use of BCS for DCIS at our institution, but a consistent, and much lower, use nationally. To increase breast conservation and reconstruction for DCIS, educational efforts should especially be directed toward elderly women and elderly surgeons.