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. 2021 May;187(1):245-254.
doi: 10.1007/s10549-020-06055-w. Epub 2021 Jan 1.

Patterns of treatment and outcome of ductal carcinoma in situ in the Netherlands

Jacky D Luiten  1   2 , Ernest J T Luiten  3 , Maurice J C van der Sangen  4 , Willem Vreuls  5 , Lucien E M Duijm  6   7 , Vivianne C G Tjan-Heijnen  8   9 , Adri C Voogd  10   11
Affiliations

Patterns of treatment and outcome of ductal carcinoma in situ in the Netherlands

Jacky D Luiten et al. Breast Cancer Res Treat. 2021 May.

Abstract

Purpose: To spare DCIS patients from overtreatment, treatment de-escalated over the years. This study evaluates the influence of these developments on the patterns of care in the treatment of DCIS with particular interest in the use of breast conserving surgery (BCS), radiotherapy following BCS and the use and type of axillary staging.

Methods: In this large population-based cohort study all women, aged 50-74 years diagnosed with DCIS from January 1989 until January 2019, were analyzed per two-year cohort.

Results: A total of 30,417 women were diagnosed with DCIS. The proportion of patients undergoing BCS increased from 47.7% in 1995-1996 to 72.7% in 2017-2018 (p < 0.001). Adjuvant radiotherapy following BCS increased from 28.9% (1995-1996) to 89.6% (2011-2012) and subsequently decreased to 74.9% (2017-2018; p < 0.001). Since its introduction, the use of sentinel lymph node biopsy (SLNB) increased to 63.1% in 2013-2014 and subsequently decreased to 52.8% in 2017-2018 (p < 0.001). Axillary surgery is already omitted in 55.8% of the patients undergoing BCS nowadays. The five-year invasive relapse-free survival (iRFS) for BCS with adjuvant radiotherapy in the period 1989-2010, was 98.7% [CI 98.4% - 99.0%], compared to 95.0% [CI 94.1% -95.8%] for BCS only (p < 0.001). In 2011-2018, this was 99.3% [CI 99.1% - 99.5%] and 98.8% [CI 98.2% - 99.4%] respectively (p = 0.01).

Conclusions: This study shows a shift toward less extensive treatment. DCIS is increasingly treated with BCS and less often followed by additional radiotherapy. The absence of radiotherapy still results in excellent iRFS. Axillary surgery is increasingly omitted in DCIS patients.

Keywords: Breast cancer screening; Diagnostics; Ductal carcinoma in situ; Treatment.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Type of surgical treatment. BCS breast conserving surgery, RTx radiotherapy
Fig. 2
Fig. 2
Trends in the use of radiotherapy after breast conserving surgery divide by grade since 2001
Fig. 3
Fig. 3
Trends in sentinel lymph node biopsy divided by grade
Fig. 4
Fig. 4
Trends in sentinel lymph node biopsy divided by type of surgical treatment
Fig. 5
Fig. 5
Trends in axillary treatment in breast conserving surgery. ALND axillary lymph node dissection, SLNB sentinel lymph node biopsy
Fig. 6
Fig. 6
a Invasive relapse-free survival for the period 1989–2010, including numbers at risk, b Invasive relapse-free survival for the period 2011–2018, including numbers at risk
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