Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA.
J Natl Cancer Inst. 2012 Apr 18;104(8):614-21. doi: 10.1093/jnci/djs167. Epub 2012 Apr 5.
Breast-conserving surgery (BCS) is the most common treatment for ductal carcinoma in situ (DCIS); however, how often women experience subsequent diagnostic evaluations over time is not known.
We identified 2948 women with DCIS who were treated with BCS from 1990 to 2001 and followed for up to 10 years at three integrated health-care delivery systems. We calculated the percentages of diagnostic mammograms and ipsilateral invasive procedures following the initial breast excision to treat DCIS, estimated the 10-year cumulative incidence of these procedures, and determined hazard ratios for both types of procedures with Cox regression modeling. All statistical tests were two-sided.
Over 10 years, 907 women (30.8%) had 1422 diagnostic mammograms and 1813 (61.5%) had 2305 ipsilateral invasive procedures. Diagnostic mammograms occurred in 7.3% of women in the first 6 months and continued at a median annual rate of 4.3%. Ipsilateral invasive procedures occurred in 51.5% of women in the first 6 months and continued at a median annual rate of 3.1%. The estimated 10-year cumulative risk of having at least one diagnostic mammogram after initial DCIS excision was 41.0% (95% confidence interval [CI] = 38.5% to 43.5%); at least one invasive procedure, 65.7% (95% CI = 63.7% to 67.8%); and either event, 76.1% (95% CI = 74.1% to 78.1%). Excluding events in the first 6 months following initial DCIS excision, corresponding risks were 36.4% (95% CI = 33.8% to 39.0%) for diagnostic mammograms, 30.4% (95% CI = 26.9% to 33.8%) for invasive procedures, and 49.5% (95% CI = 45.6% to 53.5%) for either event.
Women with DCIS treated with BCS continue to have diagnostic and invasive breast procedures in the conserved breast over an extended period. The frequency of ongoing diagnostic breast evaluations should be included in discussions about treatment.
保乳手术（BCS）是导管原位癌（DCIS）最常见的治疗方法；然而，目前尚不清楚女性在多长时间内会进行多少次后续诊断评估。
我们在三个综合性医疗服务系统中，确定了 1990 年至 2001 年间接受 BCS 治疗的 2948 例 DCIS 女性患者，并进行了长达 10 年的随访。我们计算了初始乳房切除术后治疗 DCIS 的诊断性乳房 X 光检查和同侧侵袭性手术的百分比，估计了这两种手术的 10 年累积发生率，并通过 Cox 回归模型确定了这两种手术的危险比。所有统计检验均为双侧。
在 10 年内，907 名女性（30.8%）进行了 1422 次诊断性乳房 X 光检查，1813 名女性（61.5%）进行了 2305 次同侧侵袭性手术。在最初的 6 个月内，有 7.3%的女性进行了诊断性乳房 X 光检查，随后以中位数每年 4.3%的速度继续进行。在最初的 6 个月内，有 51.5%的女性进行了同侧侵袭性手术，随后以中位数每年 3.1%的速度继续进行。估计在初始 DCIS 切除后，至少有一次诊断性乳房 X 光检查的 10 年累积风险为 41.0%（95%置信区间[CI]为 38.5%至 43.5%）；至少一次侵袭性手术的风险为 65.7%（95%CI为 63.7%至 67.8%）；两种情况的风险为 76.1%（95%CI为 74.1%至 78.1%）。排除初始 DCIS 切除后最初 6 个月内的事件后，诊断性乳房 X 光检查的相应风险为 36.4%（95%CI为 33.8%至 39.0%），侵袭性手术为 30.4%（95%CI为 26.9%至 33.8%），任何一种事件为 49.5%（95%CI为 45.6%至 53.5%）。
接受 BCS 治疗的 DCIS 女性在较长时间内继续在保留乳房中进行诊断性和侵袭性乳房检查。在讨论治疗时，应包括对持续进行的诊断性乳房评估的频率。
