Abstract
Background
Patients and Methods
Results
Conclusion
Keywords
Introduction
National Comprehensive Cancer Network. Breast cancer (version 2.2022). Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 12 Jan 2022.
Methods
American College of Surgeons. 2020. About the national cancer database. Available at: https://www.facs.org/quality-programs/cancer/ncdb/about. Accessed 23 February 2020.

Results
Characteristic | Total N = 6070 (%) | Surgery N = 5942 (%) (97.9%) | No Surgery N = 128 (%) (2.1%) | P-value |
---|---|---|---|---|
Survival/Follow-up | ||||
Average follow-up (months) Mean Median | 58.3 55.2 | 58.5 55.4 | 48.1 44.5 | |
Demographic | ||||
Race/Ethnicity NH White NH Black Hispanic Other | 4779 (78.7) 527 (8.7) 157 (2.6) 607 (10) | 4694 (79) 508 (8.5) 154 (2.6) 586 (9.9) | 85 (66.4) 19 (14.8) 3 (2.3) 21 (16.4) | .003 |
Age 80-84 85-89 90+ | 4155 (68.5) 1589 (26.2) 326 (5.4) | 4086 (68.8) 1549 (26.1) 307 (5.2) | 69 (53.9) 40 (31.3) 19 (14.8) | <.001 |
Cancer characteristics | ||||
Grade I II III Unknown | 980 (16.1) 2054 (33.8) 1760 (29.0) 163 (2.7) | 947 (15.9) 2007 (33.8) 1736 (29.2) 162 (2.7) | 33 (25.8) 47 (36.7) 24 (18.8) 1 (0.8) | .003 |
Estrogen receptor Positive Negative Borderline Missing/Unknown | 4213 (69.4) 999 (16.5) 6 (0.1) 852 (2.7) | 4130 (69.5) 987 (16.6) 6 (0.1) 819 (13.8) | 83 (64.8) 12 (9.4) 0 (0) 33 (25.8) | .249 |
Progesterone receptor Positive Negative Borderline Missing/Unknown | 3471 (57.2) 1520 (25) 18 (0.3) 1061 (17.5) | 3403 (57.3) 1500 (25.2) 17 (0.3) 1022 (17.2) | 68 (53.1) 20 (15.6) 1 (0.8) 39 (30.5) | .136 |
Diagnosis/Treatment | ||||
Breast surgery Lumpectomy Mastectomy No Surgery Unknown type | 4634 (76.3) 1305 (21.5) 128 (2.1) 3 (0.05) | 4634 (78) 1305 (22) 0 (0) 3 (0.05) | - - - - | |
Reason no surgery Contraindicated Died prior to treatment Recommended, not given Patient refusal | - - - - | 10 (24.4) 2 (4.9) 3 (7.3) 26 (63.4) | ||
Endocrine therapy Yes, No Unknown | 1114 (18.4) 4760 (78.4) 196 (3.2) | 1088 (18.3) 4664 (78.5) 190 (3.2) | 26 (20.3) 96 (75.0) 6 (4.7) | .523 |
Reason no endocrine therapy Contraindicated Died prior to treatment Recommended, not given Patient refusal | 363 (7.6) 5 (0.1) 76 (1.6) 626 (13.2) | 359 (7.7) 2 (0.04) 74 (1.6) 614 (13.2) | 4 (4.2) 3 (3.1) 2 (2.1) 12 (12.5) | <.001 |
Radiation therapy Yes, No Unknown | 1865 (30.7) 4110 (67.7) 95 (1.6) | 1857 (31.3) 3994 (67.2) 91 (1.5) | 8 (6.3) 116 (90.6) 4 (3.1) | <.001 |
Reason no radiation therapy Contraindicated Died prior to treatment Recommended, not given Patient refusal | 154 (22.4) 0 (0) 41 (6.0) 494 (71.7) | 152 (22.7) 0 (0) 39 (5.8) 480 (71.5) | 2 (11.1) 0 (0) 2 (11.1) 14 (77.8) | .374 |
Socioeconomic | ||||
Comorbidity score 0 1 2 3+ | 4895 (80.6) 967 (15.9) 171 (2.8) 37 (0.6) | 4786 (80.5) 953 (16.0) 167 (2.8) 36 (0.6) | 109 (85.2) 14 (10.9) 4 (3.1) 1 (0.8) | .478 |
Facility type CCP CCCP ARP INCP | 707 (11.6) 3212 (52.9) 1449 (23.9) 702 (11.6) | 695 (11.7) 3151 (53.0) 1405 (23.6) 691 (11.6) | 12 (9.4) 61 (47.7) 44 (34.4) 11 (8.6) | .041 |
Variable | OR | 95% CI | P-value |
---|---|---|---|
Race/Ethnicity NH White Black Hispanic Other | 1 (Ref) 0.51 1.1 0.61 | 0.3-0.9 0.26-4.58 0.35-1.08 | .012 .018 .898 |
Age 90+ 85-89 80-84 | 1 (Ref) 2.33 3.81 | 1.25-4.32 2.13-6.82 | .008 <.001 |
Comorbidity Score 3+ 2 1 0 | 1 (Ref) 1.39 2.15 1.26 | 0.14-14.31 0.26-17.84 0.16-9.70 | .783 .479 .827 |
Facility Type INCP ARP CCP CCCP | 1 (Ref) 0.44 0.69 0.74 | 0.20-0.96 0.27-1.76 0.34-1.59 | .04 .441 .437 |
Grade III II I | 1 (Ref) 0.59 0.40 | 0.36-0.97 0.23-0.69 | .039 <.001 |
Variable | HR | 95% CI | P-value |
---|---|---|---|
Surgery No Yes | 1 (Ref) 0.46 | 0.34-0.63 | <.001 |
Race NH White Black Hispanic Other | 1 (Ref) 1.12 0.86 0.96 | 0.93-1.35 0.58-1.27 0.8-1.14 | .24 .442 .635 |
Age 80-84 85-89 90+ | 1 (Ref) 1.49 3.01 | 1.32-1.67 2.48-3.64 | <.001 <.001 |
Estrogen Receptor Positive Negative Borderline | 1 (Ref) 0.88 0.9 | 0.74-1.05 0.12-6.77 | .166 .917 |
Progesterone Receptor Positive Negative Borderline | 1 (Ref) 1.24 0.59 | 1.06-1.45 0.22-1.63 | .007 .308 |
Radiation No Yes | 1 (Ref) 0.67 | 0.59-0.76 | <.001 |
Comorbidity Score 0 1 2 3+ | 1 (Ref) 1.26 2.31 2.02 | 1.09-1.45 1.74-3.07 1.08-3.78 | .002 <.001 .027 |
Tumor Size ≤2 cm 2-5 cm ≥5 cm | 1 (Ref) 1.12 1.21 | 0.97-1.28 0.95-1.56 | .117 .131 |

Discussion
American College of Surgeons. 2020. About the national cancer database. Available at: https://www.facs.org/quality-programs/cancer/ncdb/about. Accessed 23 February 2020.
Society of Surgical Oncology. Choosing Wisely. 2016. Available at: http://www.choosingwisely.org/clinician-lists/sso-sentinel-node-biopsy-in-node-negative-women-70-and-over/. Accessed December 18, 2018.
Conclusion
Clinical Practice Points
- •Determining the optimal clinical care of DCIS is ongoing. Given the paucity of data on national treatment patterns and survival outcomes in older breast cancer patients, there is a need for a greater understanding of the management and outcomes of older women with DCIS.
- •Using the National Cancer Database, we describe an overall survival benefit to receipt of surgery in patients with DCIS who are age ≥80. This study identifies an overall healthy cohort of women ≥80 with DCIS, with increased utilization of surgical treatment in those who are younger and with fewer comorbidities.
- •Given the independent survival advantage to receiving surgery ± radiation therapy, emphasis should be placed on the importance of considering interventions in a shared decision-making manner and not based on age alone.
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Article info
Publication history
Footnotes
Submitted: Mar 10, 2022; Revised: Apr 14, 2022; Accepted: Apr 15, 2022