Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, USA.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Breast Cancer Res Treat. 2024 Dec;208(3):577-587. doi: 10.1007/s10549-024-07453-0. Epub 2024 Aug 16.
Trials demonstrating benefits of tamoxifen for women with ductal carcinoma in situ (DCIS) were published > 20 years ago; yet subsequent uptake of endocrine therapy was low. We estimated endocrine therapy initiation in women with DCIS between 2001 and 2018 in a community setting, reflecting more recent years of diagnosis than previous studies.
This retrospective cohort included adult females ≥ 20 years diagnosed with first primary DCIS between 2001 and 2018, followed through 2019, and enrolled in one of three U.S. integrated healthcare systems. We collected data on endocrine therapy dispensings (tamoxifen, aromatase inhibitors [AIs]) from electronic pharmacy records within 12 months after DCIS diagnosis. Using generalized linear models with a log link and Poisson distribution, we estimated endocrine therapy initiation rates over time and by patient, tumor (including estrogen receptor [ER] status), and treatment characteristics.
Among 2020 women with DCIS, 587 (29%) initiated endocrine therapy within 12 months after diagnosis (36% among 1208 women with ER-positive DCIS). Among women who used endocrine therapy, 506 (86%) initiated tamoxifen and 81 (14%) initiated AIs. Age-adjusted endocrine therapy initiation declined from 34 to 21% between 2001 and 2017; between 2015 and 2018, AI use increased from 8 to 35%. Women less likely to initiate endocrine therapy were ER-negative or had borderline/unknown or no ER test results, ≥ 65 years at diagnosis, Black, and received no radiotherapy.
One-third of women diagnosed with DCIS initiated endocrine therapy, and use decreased over time. Understanding why women eligible for endocrine therapy do not initiate is important to maximizing disease-free survival following DCIS diagnosis.
证明他莫昔芬对导管原位癌（DCIS）女性有益的试验发表于 20 多年前；然而，随后内分泌治疗的应用率较低。我们在社区环境中估计了 2001 年至 2018 年期间患有 DCIS 的女性开始内分泌治疗的情况，这反映了比以前的研究更接近最近几年的诊断。
这项回顾性队列研究纳入了 2001 年至 2018 年间诊断为首次原发性 DCIS 的成年女性（年龄≥20 岁），并随访至 2019 年，纳入了美国三个综合医疗系统中的一个。我们从电子病历中收集了 DCIS 诊断后 12 个月内内分泌治疗（他莫昔芬、芳香化酶抑制剂[AI]）配药的数据。我们使用带有对数链接和泊松分布的广义线性模型，估计了随时间和患者、肿瘤（包括雌激素受体[ER]状态）和治疗特征的内分泌治疗起始率。
在 2020 名患有 DCIS 的女性中，有 587 名（29%）在诊断后 12 个月内开始内分泌治疗（1208 名 ER 阳性 DCIS 女性中有 36%）。在使用内分泌治疗的女性中，有 506 名（86%）开始使用他莫昔芬，81 名（14%）开始使用 AI。2001 年至 2017 年，年龄调整后的内分泌治疗起始率从 34%下降至 21%；2015 年至 2018 年，AI 的使用从 8%增加至 35%。不太可能开始内分泌治疗的女性是 ER 阴性或边界/未知或没有 ER 检测结果、诊断时年龄≥65 岁、黑人，并且未接受放疗。
三分之一诊断为 DCIS 的女性开始接受内分泌治疗，并且随着时间的推移，使用量逐渐减少。了解为什么有资格接受内分泌治疗的女性没有开始治疗对于最大限度地提高 DCIS 诊断后的无病生存率非常重要。
