Recent trends and racial/ethnic differences in the incidence and treatment of ductal carcinoma in situ of the breast in California women

Chinese and South Asian ethnicity, immigration status and head and neck cancer outcomes: A population based study

OBJECTIVE

While it is known that certain ethnic and immigrant groups are at increased risk of developing head and neck cancer, the individual effects of immigration status and ethnicity on head and neck cancer outcomes is less clear. We sought examine the independent effects of immigration and Chinese and South Asian ethnicity on overall survival in a head and neck cancer patient population.

METHODS

This was a population-based retrospective matched cohort study using linked Ontario administrative databases between 1994 and 2017. Incident cancer cases were captured in long-standing residents of Chinese and South Asian ethnicity, Chinese and South Asian immigrants, as well as a reference population. Subjects were followed until death. A hard-matching approach was used to adjust for key differences and ensure both groups were balanced with respect to age, sex and cancer site. Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on overall survival while further adjusting for baseline covariates.

RESULTS

Among 1639 immigrants with head and neck cancer, matched to 3278 controls, the overall 5-year survival rate was 66% and 59%, respectively. After adjusting for between group-differences, all-cause mortality was lower for immigrants (HR 0.76[95%CI 0.69-0.83]) and individuals of Chinese ethnicity (HR 0.78[95%CI 0.68-0.90]), relative to the general population.

CONCLUSIONS

In Ontario, immigrants experience lower mortality rates following a head and neck cancer diagnosis. Individuals of Chinese ethnicity with head and neck cancer experience a survival advantage, relative to South Asian individuals and the general population.

Familiarity, Navigation, and Comprehension: Key Dimensions of Health Literacy in Pap Test Use among Korean American Women

Health literacy consists of multiple dimensions such as print and oral literacy or numeracy. Different dimensions of health literacy may have more salient impact on certain health behaviors and outcomes. Yet, evidence is limited regarding which dimensions particularly affect cervical cancer screening. The objective of this study was to examine the role of different dimensions of health literacy in cervical cancer screening among Korean American women. We used baseline data obtained from 560 Korean American women in a community-based health literacy-focused intervention study. Backward stepwise logistic regression analysis revealed that familiarity (adjusted odds ratio [AOR] = 1.20, 95% confidence interval [CI] = 1.11-1.31) and navigational health literacy (AOR = 1.10, 95% CI = 1.04-1.16) were associated with lifetime Pap test use and comprehension (AOR = 1.08, 95% CI = 1.02-1.14) with triennial Pap test screening. Prior exposure to healthcare settings and knowing how to navigate the healthcare system were more important than other health literacy dimensions for lifetime Pap test use. Understanding cancer screening-related words was most relevant to triennial Pap test use. In addition to addressing system factors such as insurance and physicians' recommendations, interventions to increase Pap test screening targeted at Korean American women are needed to address certain dimensions of health literacy such as familiarity, navigation, and comprehension.

Twenty-Five Year Trends in the Incidence of Ductal Carcinoma in Situ in US Women

BACKGROUND

The rising incidence of ductal carcinoma in situ (DCIS) since the widespread enactment of mammography screening has been well documented. Patterns in DCIS incidence among women of various ages and across different racial and ethnic groups have not been well described.

STUDY DESIGN

The Surveillance, Epidemiology, and End Results public-use data set was queried for all women aged 40 years and older diagnosed with DCIS between 1990 and 2014. Annual age-adjusted incidence rates were compared among white, black, Hispanic, and Asian-Pacific Islander women. Additionally, using mammography screening data obtained from the CDC, patterns in mammography screening over time and as they relate to DCIS incidence rates by race and ethnicity were evaluated.

RESULTS

We identified 200,400 women aged 40 years or older with DCIS. Between 1998 and 2014, a period that saw flux in national breast screening guidelines, DCIS incidence rates increased in blacks, Hispanics, and Asian-Pacific Islanders, but remained relatively unchanged in whites (increase in number of DCIS diagnoses per 100,000 individuals in the population per year among blacks +0.66/p < 0.01, Hispanics +3.0/p < 0.01, Asian-Pacific Islanders +0.53/p < 0.01, and whites +0.07/p = 0.21). After accounting for age, year of diagnosis, and mammography screening rates, DCIS incidence was found to be similar between white and black women (0.8 fewer diagnoses per 100,000 individuals compared with whites; p = 0.36) but lower for Hispanic women (9.7 fewer diagnoses per 100,000 individuals compared with whites; p < 0.01).

CONCLUSIONS

The DCIS incidence rates are influenced substantially by breast cancer mammography screening patterns. However, differences exist by race and ethnicity and are not fully explained by screening mammography trends alone. Consideration should be given to including race and ethnicity in determining optimal breast screening guidelines.

Opportunistic mammography screening provides effective detection rates in a limited resource healthcare system

Background

Breast cancer is the leading cause of cancer deaths in women world-wide. In low and middle income countries, where there are no population-based mammographic screening programmes, late presentation is common, and because of inadequate access to optimal treatment, survival rates are poor. Mammographic screening is well-studied in high-income countries in western populations, and because it has been shown to reduce breast cancer mortality, it has become part of the healthcare systems in such countries. However the performance of mammographic screening in a developing country is largely unknown.

This study aims to evaluate the performance of mammographic screening in Malaysia, a middle income country, and to compare the stage and surgical treatment of screen-detected and symptomatic breast cancer.

Methods

A retrospective review of 2510 mammograms performed from Jan to Dec 2010 in a tertiary medical centre is carried out. The three groups identified are the routine (opportunistic) screening group, the targeted (high risk) screening group and the diagnostic group. The performance indicators of each group is calculated, and stage at presentation and treatment between the screening and diagnostic group is analyzed.

Results

The cancer detection rate in the opportunistic screening group, targeted screening group, and the symptomatic group is 0.5 %, 1.25 % and 26 % respectively. The proportion of ductal carcinoma in situ is 23.1 % in the two screening groups compared to only 2.5 % in the diagnostic group. Among the opportunistic screening group, the cancer detection rate was 0.2 % in women below 50 years old compared to 0.65 % in women 50 years and above. The performance indicators are within international standards. Early-staged breast cancer (Stage 0–2) were 84.6 % in the screening groups compared to 61.1 % in the diagnostic group.

Conclusion

From the results, in a setting with resource constraints, targeted screening of high risk individuals will give a higher yield, and if more resources are available, population-based screening of women 50 and above is effective.

Opportunistic mammographic screening is feasible and effective in a middle income country with performance indicators within international standards. Waiting until women are symptomatic will lead to more advanced cancers.

Development and validation of the assessment of health literacy in breast and cervical cancer screening

For many people limited health literacy is a major barrier to effective preventive health behavior such as cancer screening, yet a comprehensive health literacy measure that is specific to breast and cervical cancer screening is not readily available. The purpose of this article is to describe the development and testing of a new instrument to measure health literacy in the context of breast and cervical cancer screening, the Assessment of Health Literacy in Cancer Screening (AHL-C). The AHL-C is based on Baker's conceptualization of health literacy and modeled from the two most popular health literacy tests, the Rapid Estimate of Adult Literacy in Medicine and the Test of Functional Health Literacy in Adults. The AHL-C consists of four subscales; print literacy, numeracy, comprehension, and familiarity. We used baseline data from 560 Korean American immigrant women who participated in a community-based randomized trial designed to test the effect of a health literacy-focused intervention to promote breast and cervical cancer screening. Rigorous psychometric testing supports that the AHL-C is reliable, valid, and significantly correlated with theoretically selected variables. Future research is needed to test the utility of the AHL-C in predicting cancer screening outcomes.

Impact of race and ethnicity on features and outcome of ductal carcinoma in situ of the breast

BACKGROUND

The impact of race and ethnicity on the biologic features and outcome variables of women who are diagnosed with preinvasive breast cancer-ductal carcinoma in situ (DCIS)-has not been addressed widely in the published literature.

METHODS

Patient demographic, clinical, and pathologic features and outcome variables were analyzed with respect to the patient's initial self-reported race/ethnicity among women who received treatment for a diagnosis of pure DCIS from 1996 to 2009.

RESULTS

Of 1902 patients, 1411 were white (74.2%), 214 were African American (11.3%), 175 were Hispanic (9.1%), and 102 were Asian/Pacific Islander (5.4%). The majority of patients were between ages 41 and 70 years (83%). Patients of Hispanic and Asian/Pacific Islander descent were significantly younger than white and African American patients (P < .001). DCIS size and grade, the presence of necrosis, and the frequency of breast-conserving surgery did not differ significantly between groups. African American patients aged >70 years and Hispanic patients aged <50 years were significantly more likely to have estrogen receptor-positive DCIS than patients of other races in the same age categories (P < .001). Adjuvant radiotherapy and tamoxifen were received significantly less often by white women (P < .001). At a median follow-up of 4.8 years (range, 1-14 years), recurrence rates and the development of contralateral breast cancer did not differ significantly among racial/ethnic groups when stratified by treatments received.

CONCLUSIONS

There was variation in age at presentation, biologic features, and treatment of DCIS among the different ethnic groups. Additional studies with larger numbers of ethnic minority patients are needed to confirm whether the consistent application of evidence-based treatment practices presents an opportunity for reducing disparities in patients with DCIS.

Potential impact of USPSTF recommendations on early diagnosis of breast cancer

OBJECTIVE

Current US Preventive Services Task Force (USPSTF) guidelines recommend against routine screening mammography in women aged 40-49 years. However, diagnosis of early-stage breast cancer relies on mammographic screening for detection. We hypothesized that screening at younger age may be important for detecting earlier and more treatable cancers for women in different demographic groups.

METHODS

All women with ductal carcinoma in situ (DCIS) or T1N0 breast cancer between 2004 and 2008 in the California Cancer Registry were evaluated. Patients were divided into: (1) women aged 40-49 years, who would be excluded from USPSTF recommendations for screening, and (2) women aged 50-74 years, who are recommended for screening. Patients in the two age groups were compared by race/ethnicity, socioeconomic status (SES), and hormone receptor (HR), human epidermal growth factor receptor 2 (HER-2), and triple-negative (TN) status.

RESULTS

Of 46,691 patients identified, 22.6% were aged 40-49 years, and 77.4% were aged 50-74 years. Younger women with DCIS had statistically higher odds of being HR positive and having higher SES, and Hispanic and Asian/Pacific Islander (PI) race/ethnicity, while younger women diagnosed with T1N0 breast cancer had higher odds of being HR positive, HER-2 positive, and triple negative and of having higher SES and non-white race/ethnicity.

CONCLUSIONS

Young Hispanic, Asian/PI, and non-Hispanic (NH) Black women in California have greater odds of being diagnosed with early breast cancer than their older counterparts. Excluding 40-49-year-old women from screening could impact early diagnosis of HR-positive, HER-2-positive, and TN tumors. Implementation of USPSTF recommendations could disproportionately impact non-white women and potentially lead to more advanced presentation at diagnosis.

Adjuvant hormonal therapy use among women with ductal carcinoma in situ

OBJECTIVE

In the absence of consistent guidelines for the use of adjuvant hormonal therapy (HT) in treating ductal carcinoma in situ (DCIS), our purpose was to explore a variety of factors associated with discussion, use, and discontinuation of this therapy for DCIS, including patient, tumor, and treatment-related characteristics and physician-patient communication factors.

METHODS

We identified women from eight California Cancer Registry regions diagnosed with DCIS from 2002 through 2005, aged ≥18 years, of Latina or non-Latina white race/ethnicity. A total of 744 women were interviewed an average of 24 months postdiagnosis about whether they had (1) discussed with a physician, (2) used, and (3) discontinued adjuvant HT.

RESULTS

Although 83% of women discussed adjuvant HT with a physician, 47% used adjuvant HT, and 23% of users reported discontinuation by a median of 11 months. In multivariable adjusted analyses, Latina Spanish speakers were less likely than white women to discuss therapy (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.69) and more likely to discontinue therapy (OR 2.67, 95% CI 1.05-6.81). Seeing an oncologist for follow-up care was associated with discussion (OR 5.10, 95% CI 3.14-8.28) and use of therapy (OR 4.20, 95% CI 2.05-8.61). Similarly, physician recommendation that treatment was necessary vs. optional was positively associated with use (OR 11.2, 95% CI 6.50-19.4) and inversely associated with discontinuation (OR 0.38, 95% CI 0.19-0.73).

CONCLUSIONS

Physician recommendation is an important factor associated with use and discontinuation of adjuvant HT for DCIS. Differences in discussion and discontinuation of therapy according to patient characteristics, particularly ethnicity/language, suggest challenges to physician-patient communication about adjuvant HT across a language barrier.

Disease-free probability after the first primary ductal carcinoma in situ of the breast: a comparison between African-American and White-American women

Compelling evidence about the differences in the biology and behavior of invasive breast cancer between African-American (AA) and White-American (WA) women motivate inquiry into comparing the clinicopathology of non-invasive breast cancer (ductal carcinoma in situ, DCIS). AA and WA women diagnosed with their first primary DCIS between 1990 and 1999 were identified from the institutional tumor registry. Data on method of presentation, treatment, and patient characteristics were retrieved from electronic medical records. Patients were followed up through the medical records until the diagnosis of a subsequent cancer or the last day of contact with the institution. A total of 100 (29.6%) AAs and 236 (70.4%) WAs with the mean age of 60 (SD ± 13) and 57 (SD ± 12), respectively, contributed to this study. DCIS was detected during routine screening mammography for 81% (n = 81) of AAs and 88.4% (n = 206) of WAs (P = 0.073). Differences in the distributions of grade, margin status, necrosis, or treatment modalities were not statistically significant between AAs and WAs. Analysis of competing risks Cox proportional hazard multivariate modeling yielded a significant 8-year cumulative risk of a second cancer for AAs but only in the ipsilateral breast (HR = 3.96, 95% CI 1.42-11.04, P = 0.01). Despite comparable clinical presentation and treatment, 8 years after the initial treatment, AAs experienced a higher risk of second breast cancer in ipsilateral but not in the contralateral breast. The observed excess risk of a second cancer in the ipsilateral breast may suggest of intrinsic differences in the biology of cancer.

Ductal carcinoma in situ: risk factors and impact of screening

BACKGROUND

The National Institutes of Health Office of Medical Applications of Research commissioned a structured literature review on the incidence of ductal carcinoma in situ (DCIS) as a background paper for the State of the Science Conference on Diagnosis and Management of DCIS.

METHODS

Published studies were abstracted from MEDLINE and other sources. We include articles published through January 31, 2009; 92 publications were abstracted.

RESULTS

DCIS incidence rose from 1.87 per 100,000 in 1973-1975 to 32.5 per 100,000 in 2005. Increases in incidence were greatest in tumors without comedo necrosis. Incidence increased in all ages but more in women older than 50 years. Increased use of mammography explains some but not all of the increased incidence. Risk factors for incident DCIS include older age and positive family history. Whereas tamoxifen prevents both invasive breast cancer and DCIS, raloxifene is associated with decreased invasive breast cancer but not decreased DCIS.

CONCLUSIONS

Scientific questions deserving further investigation include the relationship between mammography use and DCIS incidence and the role of chemoprevention for reducing the incidence of DCIS and invasive breast cancer.

Comparison of breast cancer survival in two populations: Ardabil, Iran and British Columbia, Canada

Background

Patterns in survival can provide information about the burden and severity of cancer, help uncover gaps in systemic policy and program delivery, and support the planning of enhanced cancer control systems. The aim of this paper is to describe the one-year survival rates for breast cancer in two populations using population-based cancer registries: Ardabil, Iran, and British Columbia (BC), Canada.

Methods

All newly diagnosed cases of female breast cancer were identified in the Ardabil cancer registry from 2003 to 2005 and the BC cancer registry for 2003. The International Classification of Disease for Oncology (ICDO) was used for coding cancer morphology and topography. Survival time was determined from cancer diagnosis to death. Age-specific one-year survival rates, relative survival rates and weighted standard errors were calculated using life-tables for each country.

Results

Breast cancer patients in BC had greater one-year survival rates than patients in Ardabil overall and for each age group under 60.

Conclusion

These findings support the need for breast cancer screening programs (including regular clinical breast examinations and mammography), public education and awareness regarding early detection of breast cancer, and education of health care providers.

Ductal carcinoma in situ in African American versus Caucasian American women: analysis of clinicopathologic features and outcome

BACKGROUND

Invasive breast carcinoma has a more aggressive phenotype and a higher mortality rate in African American (AA) than in Caucasian American (CA) women. The characteristics of ductal carcinoma in situ (DCIS) in the AA population have not been extensively studied.

METHODS

The authors reviewed cases of DCIS diagnosed in AA and CA patients between 1996 and 2000 at their institution. Treatment and outcome were obtained from the clinical charts and the Surveillance, Epidemiology, and End Results database. They identified 217 AA (61%) and 141 CA (39%) patients.

RESULTS

AA women were significantly older at diagnosis (61 years vs 56 years, P = .001), and the size of the tumor was larger in AA patients (P = .001). The other pathological features examined were not statistically different between the 2 groups. Treatments with surgery and radiation were also similar. However, the CA patients were more likely to receive hormone therapy. Recurrence rate as DCIS or invasive carcinoma was similar in both patient groups, as was death due to disease. Time to recurrence with invasive carcinoma, however, was shorter for AA patients (32.8 +/- 13 vs 58 +/- 9; P = .02). Only overall survival (OS) rate was higher for CA patients (92% vs 71% at 10 years; P = .003).

CONCLUSIONS

Unlike invasive carcinoma, DCIS is diagnosed at a later age in AA patients. Except for larger size, DCIS does not have a more aggressive histology in AA patients. Treatment and recurrence rate were similar in both groups, as was death due to breast cancer. OS, however, was worse in AA women.

Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women

Despite rapidly increasing incidence rates of breast cancer, recent immigrants such as Korean-American (KA) women report disproportionately lower utilization of screening tests compared with other ethnic groups. Early screening of breast cancer for this population may be greatly facilitated by indigenous lay health workers (LHWs). We conducted an intervention trial with a 6-month follow-up. Trained LHWs recruited 100 KA women 40 years of age or older who had not had a mammogram during the past 2 years. Ninety-three completed follow-up questionnaires. A 120-min, in-class education combined with LHW follow-up counseling and navigation assistance through the health care system was provided. Rates of breast cancer screening behaviors significantly increased at 6 months (P < 0.001); changes between pre- and post-intervention were 31.9% for mammography, 23% for clinical breast examination and 36.2% for breast self-examination. Modesty toward screening significantly decreased over time, but we did not find any significant differences in breast cancer knowledge and beliefs before and after the intervention. Results support the efficacy of this neighborhood-based, culturally sensitive intervention. Further research should seek to replicate these findings and to incorporate more self-care skills such as health literacy when designing an intervention program for linguistically and culturally isolated immigrant women.

Information exchange and decision making in the treatment of Latina and white women with ductal carcinoma in situ

The natural history of ductal carcinoma in situ (DCIS) is largely unknown, and its optimal treatment remains controversial. Using semi-structured interviews, this study compared 18 White and 16 Latina women's understanding of their DCIS diagnosis, treatment decision-making processes, and satisfaction with care. Ethnic differences were observed in cognitive and emotional responses to DCIS, with White women generally reporting a better understanding of their diagnosis and treatment, and Latinas reporting more distress. Regardless of ethnicity, women with DCIS preferred that physicians discuss treatment options and attend to their informational and emotional needs. Satisfaction was associated with adequate information, expediency of care, and physicians' sensitivity to patients' emotional needs.

Do age and ethnicity predict breast cancer treatment received? A cross-sectional urban population based study. Breast cancer treatment: age and ethnicity

PURPOSE

To evaluate the treatment patterns of women aged 55 years or older with newly diagnosed breast cancer and to examine the association between age and ethnicity/race on treatment selection.

METHODS

A cross-sectional survey between January 1 and June 30, 2001 of 401 women was performed of Hispanic, black and non-Hispanic white women in Los Angeles County, aged 55 years or older with newly diagnosed breast cancer. Regression analysis examined the association between: (a) age and treatment selection and (b) ethnicity/race and treatment selection, adjusting for the effect of possible confounders.

RESULTS

In this study of urban breast cancer patients (64.1% response rate), blacks were less likely to receive hormone (OR=0.36) or chemotherapy therapy (OR=0.50) while older patients were less likely to receive lymph node dissection after lumpectomy (OR=0.48) and chemotherapy (OR=0.22).

CONCLUSION

Although there are racial and age disparities in breast cancer treatment, other factors such as education, income status, insurance plan, functional status, and comorbidity also play an important role.

Influence of mammographic screening on trends in breast-conserving surgery in Ireland

Debate exists about the influence of screening on breast cancer surgery. We compared rates and odds of mastectomy and breast-conserving surgery (BCS) during 1994-1999 between Northern Ireland, which has had organized mammographic screening (age group 50-64) since 1993, and the Republic of Ireland, where large-scale screening did not begin until 2000. Trends in BCS were similar in both populations: significant increases in BCS rates for age groups 20-49 and, especially, 50-64, and significant increases in mastectomy rates for age group 65+ only. Use of BCS among surgical patients was significantly higher in Northern Ireland (46%) than the Republic of Ireland (35%) and, in Northern Ireland, was significantly higher in age group 50-64 than other age groups. Geographic and age-related variations were substantially, but not wholly, explained by tumour characteristics and screen-detection status. Among Northern Ireland women aged 50-64, BCS use among screen-detected cases, even after adjustment for tumour characteristics, was 40-50% higher and increased more rapidly during 1994-1999 than among other cases. However, trends in BCS in Northern Ireland were not explained by changes in screen-detection status or tumour characteristics. Our findings are consistent with expectations that mammographic screening, together with modern treatment guidelines, should lead to reduced use of mastectomy and increased (proportional) use of BCS. But similar trends occurred in the absence of large-scale screening (in the Republic of Ireland), and surgical treatment of screen-detected cases did not reflect tumour characteristics alone.

Ductal Carcinoma in Situ: Trends in Geographic, Temporal, and Demographic Patterns of Care and Survival

While long-term prognosis is excellent, treatment of ductal carcinoma in situ (DCIS) remains controversial and inconsistent. The purpose of this study was to track geographic and temporal patterns of care for women diagnosed with DCIS, and analyze subsequent cancer-specific risk of mortality. Subjects for this study were 41,245 women diagnosed with primary DCIS in the National Surveillance, Epidemiology, and End Results (SEER) program from 1973 through 2000. Variables analyzed included patient age, year of diagnosis, SEER site of residence at the time of diagnosis, treatment (surgery, radiation), race, age, and hormone (estrogen and progesterone) receptor status. The percentage of women diagnosed with DCIS out of the total number of women diagnosed with breast cancer increased steadily between 1973 and 2000, with the largest increase occurring around 1985. Breast conserving surgery (BCS) utilization increased over time for each SEER site to the current proportions, ranging from 49.5% in Utah to 76.9% in Connecticut. Younger women were significantly more likely to receive mastectomy and had significantly lower risk of death. Women receiving BCS who also had radiation therapy (RT) had a significantly lower risk of death, although those receiving mastectomy had the lowest risk of death. Black women and Asian/Pacific island women were significantly more likely to receive BCS, although black women were less likely to receive follow-up RT and had a significantly increased risk of death. Racial and age differences in the treatment of DCIS resulted in significantly disparate rates of survival, which should be considered in public health programming. Mastectomy utilization resulted in improved survival, although additional studies may elucidate the interaction of treatment with patient age.

Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations

BACKGROUND

The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos.

METHODS

Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated.

RESULTS

The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages.

CONCLUSIONS

The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.

Changing patterns in diagnosis and treatment of ductal carcinoma in situ of the breast

BACKGROUND

The increased incidence of ductal carcinoma in situ (DCIS) of the breast and the emergence of new diagnostic and therapeutic tools like mammographic screening, stereotactic core biopsy and reconstructive surgery prompted us to investigate how these developments influenced diagnosis and treatment.

METHODS

Clinical and pathological characteristics of 403 patients with DCIS consecutively treated at The Netherlands Cancer Institute between 1986 and 2002 were evaluated and the effect of introduction of mammographic screening, stereotactic core biopsy and reconstruction on diagnosis and treatment was studied.

RESULTS

Following the nationwide introduction of mammographic screening the number of non-symptomatic DCIS increased from 47 to 77%. Introduction of stereotactic core biopsy resulted in a rise of one-step procedures from 26 to 52%. Mastectomy rate did not change over time: 59% overall. However, reconstruction rate increased from 17 to 39%.

CONCLUSION

This study shows a steep rise in diagnosis of non-symptomatic DCIS after introduction of screening. Further, the introduction of pre-operative diagnosis by stereotactic core biopsy resulted in a decrease of multiple surgical procedures. Mastectomy, with increasing application of breast reconstructions, remains an important treatment modality in the management of DCIS despite advancements in detection and diagnosis.

Assessing the Benefit of Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma-In-Situ

Purpose

To assess women's preferences regarding the trade-off between the risks and benefits of treatment with radiation therapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma-in-situ (DCIS).

Patients and Methods

Utilities were obtained from 120 patients and 210 nonpatients for eight relevant health states using standard gambles.

Results

Differences in utilities obtained from patient and nonpatient participants between health states were relatively similar. Reduction in the likelihood of local recurrence associated with RT did not result in higher utilities. Utilities for noninvasive recurrence were only lower after initial treatment with RT. Patient and nonpatient participants had the lowest utilities for invasive local recurrence, regardless of initial treatment or manner of salvage therapy. When comparing patient and nonpatient utilities directly, patients had higher utility for being without recurrence after initial RT and lower utility for invasive recurrence salvaged by mastectomy after initial BCS alone. None of the clinical or sociodemographic factors examined explained more than 5% of the variability in the patients' or nonpatients' utilities or their differences.

Conclusion

The principal benefit associated with adding RT to BCS for DCIS seems to be its ability to reduce invasive recurrences.