Tuttle Todd M, Jarosek Stephanie, Habermann Elizabeth B, Arrington Amanda, Abraham Anasooya, Morris Todd J, Virnig Beth A
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
J Clin Oncol. 2009 Mar 20;27(9):1362-7. doi: 10.1200/JCO.2008.20.1681. Epub 2009 Feb 17.
Some women with unilateral ductal carcinoma in situ (DCIS) undergo contralateral prophylactic mastectomy (CPM) to prevent cancer in the opposite breast. The use and trends of CPM for DCIS in the United States have not previously been reported.
We used the Surveillance, Epidemiology, and End Results database to analyze the initial treatment (within 6 months) of patients with unilateral DCIS diagnosed from 1998 through 2005. We determined the CPM rate as a proportion of all surgically treated patients and as a proportion of all patients who underwent mastectomy. We compared demographic and tumor variables in women with unilateral DCIS who underwent surgical treatment.
We identified 51,030 patients with DCIS; 2,072 patients chose CPM. The CPM rate was 4.1% for all surgically treated patients and 13.5% for patients undergoing mastectomy. Among all surgically treated patients (including breast-conserving surgery), the CPM rate increased by 148% from 1998 (2.1%) to 2005 (5.2%). Among patients who underwent mastectomy to treat DCIS (excluding patients undergoing breast-conserving surgery), the CPM rate increased by 188% from 1998 (6.4%) to 2005 (18.4%). Young patient age, white race, recent year of diagnosis, and the presence of lobular carcinoma in situ were significantly associated with higher CPM rates among all surgically treated patients and all patients undergoing mastectomy. Large tumor size and higher grade were significantly associated with increased CPM rates among all surgically treated patients but lower CPM rates among patients undergoing mastectomy.
The use of CPM for DCIS in the United States markedly increased from 1998 through 2005.
一些患有单侧导管原位癌（DCIS）的女性会接受对侧预防性乳房切除术（CPM）以预防对侧乳房患癌。此前美国尚未有关于DCIS患者CPM使用情况及趋势的报道。
我们利用监测、流行病学和最终结果数据库分析了1998年至2005年期间诊断为单侧DCIS患者的初始治疗情况（6个月内）。我们将CPM率确定为所有接受手术治疗患者的比例以及所有接受乳房切除术患者的比例。我们比较了接受手术治疗的单侧DCIS女性的人口统计学和肿瘤变量。
我们确定了51030例DCIS患者；2072例患者选择了CPM。所有接受手术治疗患者的CPM率为4.1%，接受乳房切除术患者的CPM率为13.5%。在所有接受手术治疗的患者（包括保乳手术）中，CPM率从1998年的2.1%增至2005年的5.2%，增长了148%。在因DCIS接受乳房切除术的患者（不包括接受保乳手术的患者）中，CPM率从1998年的6.4%增至2005年的18.4%，增长了188%。在所有接受手术治疗的患者以及所有接受乳房切除术的患者中，年轻患者年龄、白人种族、近期诊断年份以及小叶原位癌的存在与较高的CPM率显著相关。肿瘤体积大及分级高在所有接受手术治疗的患者中与CPM率增加显著相关，但在接受乳房切除术的患者中与较低的CPM率相关。
1998年至2005年期间，美国DCIS患者CPM的使用显著增加。
