Background: Ductal carcinoma-in situ (DCIS) is a preinvasive form of breast cancer associated with excellent outcomes after either mastectomy or breast conservation therapy. Previous studies have demonstrated declining rates of mastectomy. However, it is unclear how this pattern has changed in recent years.
Methods: Women with DCIS were identified within the National Cancer Data Base. Patients treated with lumpectomy with or without radiotherapy were compared to women treated with mastectomy on the basis of demographic, clinicopathologic, and reporting facility details using χ (2) tests and multivariable logistic regression modeling to identify factors that may influence surgical choice. Changes in the proportion of women receiving contralateral prophylactic mastectomy (CPM) were assessed in a similar fashion.
Results: We identified 212,936 women diagnosed with DCIS between 1998 and 2011. Lumpectomy was performed in 68 % (144,681) of patients. Mastectomy rates initially declined from 1998 (36 %) through 2004 (28 %), before increasing again through 2011 (33 %). Younger patient age, greater medical comorbidity, more extensive disease, higher tumor grade, treatment at an academic facility, and greater distance from the reporting facility were associated with heightened use of mastectomy (all p < 0.001). CPM also increased over time, particularly among younger patients, on multivariate analysis (p < 0.001).
Conclusions: Mastectomy utilization appears to be rising between 2004 and 2011, particularly among younger patients and those with higher-risk histopathologic features. CPM is increasing in a similar fashion. Further research is needed to understand the drivers of this change.