Treatment of ductal carcinoma in situ (DCIS) varies greatly by region and even by practitioner in the US, according to an analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.
The good news is that the number of women who received a mastectomy for DCIS decreased from 43% in 1992 to 28% in 1999. But researchers found that while many women received overly aggressive treatment, many others received treatment that wasn't aggressive enough. Overall, almost half (42%) of women undergoing mastectomy received axillary dissection, despite current treatment guidelines for DCIS recommending against it. In addition, almost half the women who received lumpectomy received no radiation therapy, despite treatment guidelines since at least 1993 recommending it.
Of the geographic areas examined, Atlanta had the highest rate of axillary dissection with mastectomy, followed by Iowa and Los Angeles. Hawaii had the highest rate of radiation therapy after breast-conserving therapy, followed by Iowa and Connecticut.
Baxter NN, Virnig BA, Durham SB, et al. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96:443-448.