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Lefeuvre D, Le Bihan-Benjamin C, Pauporté I, Medioni J, Bousquet PJ. French Medico-Administrative Data to Identify the Care Pathways of Women With Breast Cancer. Clin Breast Cancer 2017; 17:e191-e197. [PMID: 28237608 DOI: 10.1016/j.clbc.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. MATERIALS AND METHODS Women with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for 1 year. Care pathways were described, focusing on surgery (partial mastectomy [PM], total mastectomy [TM]), chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines. RESULTS The study involved 52,128 women. The most common care pathways among the 2845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were affected by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. CONCLUSION The French medicoadministrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary.
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Affiliation(s)
- Delphine Lefeuvre
- Observation, Survey and Assessment Department, Institut National du Cancer, Boulogne-Billancourt, France.
| | | | - Iris Pauporté
- Clinical Trial Department, Institut National du Cancer, Boulogne-Billancourt, France
| | - Jacques Medioni
- Paris Descartes University, Paris, France; Medical Oncology Department, Georges Pompidou European Hospital, Paris, France
| | - Philippe-Jean Bousquet
- Observation, Survey and Assessment Department, Institut National du Cancer, Boulogne-Billancourt, France
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Wadsten C, Heyman H, Holmqvist M, Ahlgren J, Lambe M, Sund M, Wärnberg F. A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years. Acta Oncol 2016; 55:1338-1343. [PMID: 27548561 DOI: 10.1080/0284186x.2016.1211317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Sweden has a long history of population-based cancer registration. The aim of our study was to assess the validity of DCIS registration in a regional Breast Cancer Quality Register (BCQR) and to analyze trends in incidence, treatment and outcome of DCIS, over a 20-year period. MATERIAL AND METHODS All patients with a diagnosis of primary DCIS reported in the BCQR of the Uppsala-Örebro healthcare region in Sweden 1992-2012 were included. Three hundred women were randomly selected and their medical records were compared to register data. The study period was divided into four time periods. RESULTS A total of 2952 women were registered with a DCIS diagnosis. In the final validation cohort of 295 patients, 23 were found to have either recurrent DCIS or invasive breast cancer and eight had LCIS. The completeness and validity of key variables were 91-99%. Twenty of 31 local recurrences were registered (65%).The proportion of DCIS to all breast cancers was 9.5%. Tumor size increased over time. The frequency of mastectomy increased from 23.0% to 39.0%. The proportion of patients receiving radiotherapy after breast conserving surgery increased from 30.1% to 67.6%. The reported local recurrence rate was 9.7% after 10 years. Reported recurrences after BCS and mastectomy were 12.0 and 7.0%, respectively. The recurrence rate did not differ between women undergoing BCS with or without radiotherapy. CONCLUSION Only 89.5% of reported DCIS was a primary pure DCIS. The completeness of primary treatment and tumor data was high. The proportion of reported local recurrences was disappointingly low, 65%. The proportion of DCIS was stable over time with a trend towards more intensified treatment. The reported recurrence rate was low independent of treatment and can reflect adequate patient selection, but also over treatment. Our results address the necessity to validate register data on a regular basis.
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Affiliation(s)
- Charlotta Wadsten
- Department of Surgery, Sundsvall Hospital, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Hanna Heyman
- Department of Surgical Sciences, Uppsala Academic Hospital, Uppsala University, Uppsala, Sweden
| | | | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Lambe
- Regional Cancer Center, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala Academic Hospital, Uppsala University, Uppsala, Sweden
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Weber RJP, van Bommel RMG, Setz-Pels W, Voogd AC, Klompenhouwer EG, Louwman MW, Strobbe LJA, Tjan-Heijnen VCG, Duijm LEM. Type and Extent of Surgery for Screen-Detected and Interval Cancers at Blinded Versus Nonblinded Double-Reading in a Population-Based Screening Mammography Program. Ann Surg Oncol 2016; 23:3822-3830. [DOI: 10.1245/s10434-016-5295-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 01/02/2023]
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Ponti A, Lynge E, James T, Májek O, von Euler-Chelpin M, Anttila A, Fitzpatrick P, Mano MP, Kawai M, Scharpantgen A, Fracheboud J, Hofvind S, Vidal C, Ascunce N, Salas D, Bulliard JL, Segnan N, Kerlikowske K, Taplin S. International variation in management of screen-detected ductal carcinoma in situ of the breast. Eur J Cancer 2014; 50:2695-704. [PMID: 25149183 PMCID: PMC4275301 DOI: 10.1016/j.ejca.2014.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. METHODS We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. RESULTS Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. CONCLUSIONS Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.
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Affiliation(s)
- Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ted James
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | | | - Maria Piera Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Masaaki Kawai
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | | | | | - Carmen Vidal
- Cancer Detection and Control Programme, Catalan Institute of Oncology, Barcelona, Spain
| | - Nieves Ascunce
- Breast Cancer Screening Programme, Instituto de Salud Pública, Navarra, Spain
| | - Dolores Salas
- General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain
| | | | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Karla Kerlikowske
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Taplin
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Epidemiology of ductal carcinoma in situ in Western Australia: implications for surgical margins and management. Breast Cancer 2014; 22:641-7. [PMID: 24777718 DOI: 10.1007/s12282-014-0531-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In 2010, the Australian Institute of Health and Welfare published a report examining the characteristics of Australian women diagnosed with ductal carcinoma in situ (DCIS). This study identified the characteristics of women who were diagnosed with DCIS in Western Australia (WA) 1996-2005, and built on a national study by determining the rate of second operation and breast cancer events (BCE) in WA. METHODS A retrospective analysis of data from the WA Cancer Registry and the Hospital Morbidity Database was undertaken. The main outcome measures were histological characteristics, second operation rate, breast cancer events. RESULTS A total of 1356 cases of DCIS were diagnosed in WA between 1996 and 2005, with a minimum 5-year follow-up. The age-standardised incidence rate in 2005 was 15.4 per 100,000 women. 72 % of patients received breast-conserving therapy for primary treatment, 18 % of patients requiring a second operation to obtain adequate margins and 35 % of patients received postoperative radiotherapy. 17.3 % of cases had a subsequent BCE, with the 5- and 10-year probabilities being 4.36 and 8.27 %, respectively. A BCE was significantly associated with age (p < 0.001), no second operation (p < 0.001) and no radiotherapy (p = 0.049 recurrence, p = 0.043 invasion). CONCLUSION This study supports the need to ensure adequate margins during primary surgery for DCIS is obtained to reduce the need for a second operation or the risk of a subsequent BCE. The consideration of mastectomy versus radiotherapy should be made in conjunction with the identified risk factors, specifically age and whether a second operation was performed.
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van Steenbergen LN, Voogd AC, Roukema JA, Louwman WJ, Duijm LEM, Coebergh JWW, van de Poll-Franse LV. Time trends and inter-hospital variation in treatment and axillary staging of patients with ductal carcinoma in situ of the breast in the era of screening in Southern Netherlands. Breast 2013; 23:63-8. [PMID: 24291376 DOI: 10.1016/j.breast.2013.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 09/04/2013] [Accepted: 11/03/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To examine variation in time and place in axillary staging and treatment of patients with ductal carcinoma in situ (DCIS) of the breast. METHODS Trends in patients with DCIS recorded in the Eindhoven Cancer Registry diagnosed in 1991-2010 (n = 2449) were examined. RESULTS The use of breast conserving surgery (BCS) went from 17% to 67% in 1991-2010 and administration of radiotherapy after BCS increased to 89%. Axillary lymph node dissection decreased to almost 0%, while sentinel node biopsy was performed in 65% of patients in 2010. The proportion who underwent BCS varied between hospitals from 49% to 80%; the proportion without axillary staging ranged from 21% to 60%. Patients with screen-detected DCIS were more likely to receive BCS. CONCLUSION There was considerable variation in the use of BCS, radiotherapy, and axillary staging of DCIS over time and between hospitals. Patients with DCIS were more likely to be treated with BCS if their disease was detected by screening.
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Affiliation(s)
- L N van Steenbergen
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands.
| | - A C Voogd
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - J A Roukema
- Department of Surgery, St. Elisabeth Hospital Tilburg, PO Box 90151, 5000 LC Tilburg, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands
| | - W J Louwman
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands
| | - L E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands
| | - J W W Coebergh
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - L V van de Poll-Franse
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands; Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands
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de Gelder R, Fracheboud J, Heijnsdijk EAM, den Heeten G, Verbeek ALM, Broeders MJM, Draisma G, de Koning HJ. Digital mammography screening: weighing reduced mortality against increased overdiagnosis. Prev Med 2011; 53:134-40. [PMID: 21718717 DOI: 10.1016/j.ypmed.2011.06.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/09/2011] [Accepted: 06/13/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Digital mammography has been shown to increase the detection of ductal carcinoma in situ (DCIS) compared to screen-film mammography. The benefits and risks of such an increase were assessed. METHODS Breast cancer detection rates were compared between 502,574 screen-film and 83,976 digital mammograms performed between 2004 and 2006 among Dutch screening participants. The detection rates were then modeled using a baseline model and two extreme models that respectively assumed a high rate of progression and no progression of preclinical DCIS to invasive cancer. With these models, breast cancer mortality and overdiagnosis were predicted. RESULTS The DCIS detection rate was significantly higher at digital mammography (1.2 per 1000 mammograms (95% C.I. 1.0-1.5)) than at screen-film mammography (0.7 per 1000 mammograms (95% C.I. 0.6-0.7)). Consequently, 287 (range progressive- non progressive model: 1-598) extra breast cancer deaths per 1,000,000 women (a 4.4% increase) were predicted to be prevented. An extra 401 (range: 165-2271) cancers would be overdiagnosed (a 21% increase). CONCLUSION Modeling predicted that digital mammography screening would further reduce breast cancer mortality by 4.4%, at a 21% increased overdiagnosis rate. The consequences of digital screening, however, are sensitive to underlying assumptions on the natural history of DCIS.
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Affiliation(s)
- Rianne de Gelder
- Erasmus MC, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Schouten van der Velden AP, Schlooz-Vries MS, Boetes C, Wobbes T. Magnetic resonance imaging of ductal carcinoma in situ: what is its clinical application? A review. Am J Surg 2009; 198:262-9. [PMID: 19375068 DOI: 10.1016/j.amjsurg.2009.01.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 01/20/2009] [Accepted: 01/20/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND After breast-conserving surgery of ductal carcinoma in situ (DCIS) of the breast or invasive breast carcinoma with an extensive intraductal component, tumor-positive surgical margins are frequently found. Therefore, the extent of the intraductal disease needs to be accurately determined preoperatively. METHODS Data for this review were identified by search of PubMed. Reference lists of selected articles were cross-searched for additional literature. RESULTS DCIS is accurately detected with magnetic resonance imaging (MRI), but the typical malignant features are inconsistently seen and most often in high-grade DCIS or in DCIS with a small invasive component. The histopathologic extent of DCIS is more accurately demonstrated with MRI. However, overestimation due to benign proliferative lesions does frequently occur. An improved depiction of DCIS could lead to improved preoperative staging. Conversely, the identification of more extensive disease on MRI could give rise to unnecessary interventions. Therefore, MRI should be used carefully and preferable in specialized and experienced centers. CONCLUSION [corrected] To date, there is no evidence that the use of MRI improves outcomes (ie, decreases recurrence rates) in patients with DCIS.
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Meijnen P, Gilhuijs KG, Rutgers EJT. The effect of margins on the clinical management of ductal carcinoma in situ of the breast. J Surg Oncol 2009; 98:579-84. [PMID: 19072848 DOI: 10.1002/jso.21041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Complete excision is key to successful breast-conserving treatment for patients diagnosed with ductal carcinoma in situ (DCIS). Patients with extensive DCIS should be considered the choice of mastectomy (followed by reconstruction), while for smaller DCIS breast-conserving treatment should be performed by complete excision. This review reports on the effect of margins on the clinical management of patients with a diagnosis of DCIS. The role of preoperative imaging including MRI, surgical procedures, and pathology are described.
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Affiliation(s)
- Philip Meijnen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Schouten van der Velden AP, van Vugt R, Van Dijck JAAM, Leer JWH, Wobbes T. Local Recurrences After Different Treatment Strategies for Ductal Carcinoma In Situ of the Breast: A Population-Based Study in the East Netherlands. Int J Radiat Oncol Biol Phys 2007; 69:703-10. [PMID: 17544591 DOI: 10.1016/j.ijrobp.2007.03.062] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 03/29/2007] [Accepted: 03/31/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Outcomes after different treatment strategies for ductal carcinoma in situ (DCIS) of the breast were analyzed for a geographically defined population in the East Netherlands. METHODS AND MATERIALS A total of 798 patients with a first diagnosis of DCIS between January 1989 and December 2003 were included and their medical records were reviewed. Survival rates for ipsilateral recurrences were calculated by the Kaplan-Meier method and a multivariate Cox proportional hazards regression model was used to evaluate the prognostic significance of different variables. RESULTS The 5-year recurrence-free survival was 75% for breast conserving surgery (BCS) alone (237 patients) compared with 91% for BCS followed by radiation therapy (RT; 153 patients) and 99% for mastectomy (408 patients, p < 0.01). Independent risk factors for local recurrences were treatment strategy, symptomatically detected DCIS, and presence of comedo necrosis. Margin status reached statistical significance only for patients treated by BCS (hazard ratio, 2.0; 95% confidence interval, 1.1-4.0) whereas significance of other prognostic variables did not change. CONCLUSIONS In a defined population outside a trial setting, RT after BCS for DCIS lowered recurrence rates. Besides the use of RT, a microscopically complete excision of DCIS is essential. This is especially true for patients with symptomatically detected DCIS and with tumors that contain comedo necrosis, as these groups are at particular high risk for recurrent disease.
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