Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis
Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis
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DOI：
10.1245/s10434-013-3121-4
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发表时间：
2013-10-01
影响因子：
3.7
通讯作者：
Tuttle, Todd M.
中科院分区：
文献类型：
--
作者：
Portschy, Pamela R.;Marmor, Schelomo;Tuttle, Todd M.
小叶原位癌（LCIS）是乳腺癌风险增加的标志。目前的指南不推荐乳房切除术作为大多数LCIS患者降低风险的策略。我们进行了一项基于人群的研究，以评估LCIS发病率和管理的国家趋势。利用监测、流行病学和最终结果数据库，我们对2000年至2009年显微镜下确诊LCIS的女性进行了回顾性队列分析。我们排除了浸润性乳腺癌或导管原位癌患者。我们评估了治疗方法的变化，包括单独活检，切除，放射治疗切除和乳房切除术。我们使用逻辑回归来确定与乳房切除术相关的时间趋势、人口统计学和患者因素。从2000年到2009年，我们确定了14,048例LCIS患者。LCIS发病率从2000年的每10万人2.0例上升到2009年的每10万人2.75例（增加38%）。在这些患者中，10%仅行活检，73%单独行切除，1%行放射切除，16%行乳房切除术。白人和年轻女性的乳房切除术率明显更高。从2000年到2009年，LCIS妇女接受乳房切除术的比例增加了50% （p < 0.01）。乳房切除术率因地理区域的不同而有显著差异，从12%到24%不等。这是第一个基于人群的分析，评估LCIS手术治疗的模式和趋势。尽管目前的建议，降低风险的手术越来越多地在美国的妇女LCIS进行。
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.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.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 %.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.