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Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Lobular carcinoma in situ (LCIS) is a marker of increased risk of breast cancer. Current guidelines do not recommend mastectomy as a strategy for risk reduction for most patients with LCIS. We conducted a population-based study to evaluate national trends in incidence and management of LCIS.

Methods

Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort analysis of women diagnosed with microscopically confirmed LCIS from 2000 through 2009. We excluded patients with invasive breast cancer or ductal carcinoma in situ. We evaluated variation in treatment, including biopsy alone, excision, excision with radiation therapy, and mastectomy. We utilized logistic regression to identify time trends, demographics, and patient factors associated with mastectomy.

Results

We identified 14,048 patients diagnosed with LCIS from 2000 to 2009. The rate of LCIS incidence increased from 2.0 per 100,000 in 2000 to 2.75 per 100,000 in 2009 (38 % increase). Of these patients, 10 % underwent biopsy only, 73 % underwent excision alone, 1 % underwent excision with radiation, and 16 % underwent mastectomy. Mastectomy rates were significantly higher among white and younger women. The proportion of women with LCIS to receive mastectomy increased by 50 % from 2000 to 2009 (p < 0.01). Mastectomy rates varied significantly based on geographic region ranging from 12 to 24 %.

Conclusions

This is the first population-based analysis evaluating patterns and trends in surgical management of LCIS. Despite current recommendations, risk-reduction surgery is increasingly performed in the United States for women with LCIS.

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Authors and Affiliations

  1. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Pamela R. Portschy MD, Rumbidzayi Nzara BA & Todd M. Tuttle MD, MS

  2. Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA

    Schelomo Marmor MPH & Beth A. Virnig PhD

Authors
  1. Pamela R. Portschy MD
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  2. Schelomo Marmor MPH
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  3. Rumbidzayi Nzara BA
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  4. Beth A. Virnig PhD
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  5. Todd M. Tuttle MD, MS
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Corresponding author

Correspondence to Todd M. Tuttle MD, MS.

Appendix: Cohort Selection

Appendix: Cohort Selection

Excluded Surgery Codes

  • 19: Local Tumor Destruction, NOS

  • 60–62, 64–69, 73–74: Radical Mastectomy, NOS

  • 70–72: Extended Radical Mastectomy

  • 90: Surgery, NOS

  • 99: Unknown if surgery performed

Included Surgery Codes

  • 0: No surgery

  • 20–24: Partial Mastectomy

  • 30: Subcutaneous Mastectomy

  • 40–49, 75: Total (Simple) Mastectomy

  • 80: Mastectomy, NOS

  • 50–59, 63: Modified Radical Mastectomy

Included Radiation Codes

  • 1: Beam radiation

  • 5: Radiation, NOS

Positive Lymph Nodes Examined Codes

  • 00: All nodes examined are negative

  • 98: No nodes were examined

  • 99: Unknown whether nodes are positive; not applicable; not stated in patient record

Stepwise Ascertainment of Final Pool of Patients

  • Start: female LCIS cases diagnoses 2000–2009 (code 8520): 59,275

  • After excluding cases younger than 18 and older than 80 at diagnosis: 52,999

  • After excluding cases diagnosed in a nursing home, by autopsy, or on death certificate: 52,989

  • After excluding cases localized, regional, distant and unstaged cases: 14,380

  • After excluding cases without microscopic confirmation by surgical code (see above codes): 14,048

  • After excluding cases from registries with less than five hundred LCIS cases: 11,641

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Portschy, P.R., Marmor, S., Nzara, R. et al. Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis. Ann Surg Oncol 20, 3240–3246 (2013). https://doi.org/10.1245/s10434-013-3121-4

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  • DOI: https://doi.org/10.1245/s10434-013-3121-4

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