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- Title
Tamoxifen Initiation After Ductal Carcinoma In Situ.
- Authors
Nichols, Hazel B.; Bowles, Erin J.A.; Islam, Jessica; Madziwa, Lawrence; Stürmer, Til; Tran, Diem‐Thy; Buist, Diana S.M.
- Abstract
Background. Endocrine therapy initiation after ductal carcinoma in situ (DCIS) is highly variable and largely unexplained. National guidelines recommend considering tamoxifen for women with estrogen receptor-positive (ER1) DCIS or who undergo excision alone. We evaluated endocrine therapy use after DCIS over a 15-year period in an integrated health care setting to identify factors related to initiation. Methods. Female Group Health Cooperative enrollees ages 18-89 years with a DCIS diagnosis during 1996-2011 were eligible for inclusion. Endocrine therapy was identified through pharmacy records. Tumor and treatment information were from tumor registry reports; demographics and other risk factors were from questionnaires and electronic medical records. Relative risks (RRs) and 95% confidence intervals (CIs) for endocrine therapy initiation were calculated using multivariable generalized linear models. Results. We identified 727 women with a DCIS diagnosis, including 163 (22%) who initiated endocrine therapy (149 tamoxifen, 14 aromatase inhibitor). Younger women were more likely to initiate endocrine therapy (RR 1.69; 95% CI 1.16-2.46 for ages 45-54 vs. 65-74 years). Compared with breast-conserving surgery (BCS) with radiation, women who had BCS alone (RR 0.46;95% CI 0.25-0.84) or mastectomy (RR 0.54; 95% CI 0.39-0.75) were less likely to use endocrine therapy. ER testing increased from 4% of DCIS cases in 2001 to 71% in 2011; however, endocrine therapy initiation decreased from 58% of ER1 DCIS in 2001-2005 to 37% in 2009-2011. Conclusion. Increasing ER testing since 2001 has not corresponded to parallel increases in endocrine therapy initiation. Age, surgery, and radiation were the primary factors associated with initiation.
- Subjects
BREAST cancer diagnosis; BREAST cancer surgery; BREAST cancer chemotherapy; AGE distribution; BREAST cancer; CONFIDENCE intervals; HORMONE therapy; LONGITUDINAL method; MASTECTOMY; MEDICAL protocols; NOSOLOGY; QUESTIONNAIRES; RACE; RESEARCH funding; TAMOXIFEN; WOMEN'S health; DECISION making in clinical medicine; RELATIVE medical risk; RETROSPECTIVE studies; AROMATASE inhibitors; DUCTAL carcinoma; FAMILY history (Medicine); ELECTRONIC health records; ODDS ratio; TUMOR grading; DIAGNOSIS
- Publication
Oncologist, 2016, Vol 21, Issue 2, p134
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2015-0310