Variation in the management of ductal carcinoma in situ in the UK: Results of the Mammary Fold National Practice Survey

The Mammary Fold Academic and Research Collaborative

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Abstract

Introduction
Ductal carcinoma in situ (DCIS) accounts for approximately 10% of all newly-diagnosed breast cancers in the UK. The latest national guidelines were published in 2009 and may not reflect current best practice. We aimed to explore variation in the current management of DCIS to support the need for updated guidelines.

Methods
A national practice questionnaire was developed by the Mammary Fold Academic Committee (MFAC) focusing on the pre, intra and post-operative management of DCIS. Trainees at UK breast units were invited to complete the questionnaire at their multidisciplinary team meeting to provide a comprehensive picture of current national practice.

Results
76 of 144 UK breast units (52.8%) participated in the survey. Variation was observed in radiological pre-operative assessment with only 33/76 units (43.4%) performing routine ultrasound assessment of the tumour or axilla. There was no clear consensus regarding indications for mastectomy; multifocality (38.2%) and extensive microcalcifications (34.2%) were the most frequent indications. 34/76 units (44.7%) offered nipple sparing mastectomy. 33/76 units (43.3 %) perform sentinel node biopsy in the presence of a palpable/mass lesion and 51/76 (67.1 %) at the time of mastectomy. The most widely accepted pathological radial margin remained 2mm (36.8%). The commonest factors in decision-making for radiotherapy were tumour grade (51.3%) and size (35.5%). Only 12 units (15.8 %) routinely used the Van Nuys prognostic index. Approximately half of all breast units offer clinical long-term follow-up.

Discussion
There is marked variation in the management of DCIS in the UK. Updated evidence-based guidelines may standardise practice and improve outcomes for patients.
Original languageEnglish
Pages (from-to)1153–1161
Number of pages9
JournalEuropean Journal of Surgical Oncology
Volume42
Issue number8
Early online date1 Jun 2016
DOIs
Publication statusPublished - Aug 2016

Structured keywords

  • Centre for Surgical Research

Keywords

  • Ductal carcinoma in situ
  • survey
  • management
  • national practice

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