© 2004 by Oxford University Press
© 2004 Oxford University Press
CORRESPONDENCE |
Re: Trends in the Treatment of Ductal Carcinoma In Situ of the Breast
Affiliations of authors: National Breast Cancer Centre, Camperdown, NSW, Australia
Correspondence to: Helen Zorbas, MBBS, National Breast Cancer Centre, 92 Parramatta Rd., Camperdown, NSW 2050, Australia (e-mail directorate{at}nbcc.org.au)
Baxter et al. (1) bring to light a number of issues about the diagnosis and management of ductal carcinoma in situ (DCIS) of the breast. It is interesting that the proportion of comedo histology decreased during the period from 1992 through 1999, that less than 50% of lesions had a reported grade, and that tumor size was not reported in one-third of cases.
The National Breast Cancer Centre (NBCC) in Australia commissioned a population-based study (2) that reviewed the epidemiology and pathology of DCIS reported to the cancer registry in one large Australian state from 1995 through 2000. The study identified a number of trends in important areas of reporting and management. First, about 65% of all cases over the 6-year period were identified through initial contact with the national population-based screening program, BreastScreen Australia. Second, fewer cases of DCIS were identified with comedo histology from 1998 through 2000 than from 1995 through 1997 (10% versus 26%, respectively). Finally, pathology reports of DCIS from 1998 through 2000 were more complete than earlier reports. For instance, the joint reporting of both size and grade were not recorded in 27% of reports from 1995 through 1997 but had decreased to only 9% of reports from 1998 through 2000.
The NBCC report found that surgical management changed during the study period. Approximately two-thirds of women underwent breast-conserving therapy alone from 1995 through 1997, compared with about three-fourths of women from 1998 through 2000. This change was mainly because of a twofold decrease in the proportion of women undergoing mastectomy alone. The rates of axillary surgery remained stable over the period. We compare salient differences between the two studies in Table 1.
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The importance of accurate pathology reporting of DCIS is critical in determining treatment for women diagnosed with this disease and may provide information for the future definition of more tailored treatment regimes. In Australia, guidelines on the handling, description, and reporting of breast cancer specimens (including invasive breast cancer and DCIS) were developed in 2001 (3), and then recommendations about the clinical management of DCIS were released in 2003 (4). These recommendations are important to clinicians and to the increasing number of women diagnosed with DCIS considering management options for a disease that, although preinvasive, has the potential to recur as a life-threatening disease. The uncertainties about DCIS are well recognized. However, they do not negate the need to provide clinical guidance through evidence-based recommendations and to highlight areas in which evidence is not currently available.
REFERENCES
1 Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2004;96:443–8.
2 Kricker A, Goumas C. Ductal carcinoma in situ in New South Wales women in 1995-2000. Camperdown (Australia): National Breast Cancer Centre; 2004.
3 Australian Cancer Network Working Party. The pathology reporting of breast cancer: a guide for pathologists, surgeons, radiologists and oncologists. North Sydney (Australia): Australian Cancer Network; 2001.
4 National Breast Cancer Centre. The clinical management of ductal carcinoma in situ, lobular carcinoma in situ and atypical hyperplasia of the breast. Camperdown (Australia): National Breast Cancer Centre; 2003.
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Del.icio.us What's this?
J Natl Cancer Inst 2004 96: 1257.
J Natl Cancer Inst 2004 96: 1258-1259.
J Natl Cancer Inst 2004 96: 1259-1260.
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