Abstract

Introduction: Patients diagnosed with ductal carcinoma in situ (DCIS) generally enjoy a favorable prognosis, yet mastectomy is an increasingly popular option for these patients. Factors influencing the decision to pursue definitive treatment of DCIS with mastectomy and subsequent breast reconstruction are not well understood. Methods: A retrospective cohort study of 196 consecutive patients presenting to the Yale Breast Center with DCIS from 2000 through 2003 was conducted under an IRB-approved protocol. Statistical analyses comparing patients who were treated with mastectomy with or without breast reconstruction to those who were not treated with these modalities were performed using SPSS statistical software. Results: Of the 196 patients who underwent surgery for DCIS in our analysis, 47 (24.0%) were treated with mastectomy, and 149 (76.0%) had breast conserving surgery. Of the mastectomy patients, 28 (59.6%) elected to have reconstruction. The median age of all patients at the time of diagnosis of their initial DCIS was 55.1 years (range 35.8 to 88.9). On bivariate analysis, patients who opted for mastectomy were younger than those who were treated with BCS (median age 51.8 vs. 56.5 years, p=0.017). Patients undergoing mastectomy were more likely to have higher grade tumors compared to patients undergoing BCS. Among patients treated with mastectomy, those who opted for reconstruction were younger than those who did not receive reconstruction (49.4 vs. 56.9 years, p=0.024). Race, DCIS tumor size, and histologic subtype were not significantly associated with the decision to pursue mastectomy nor the decision to pursue reconstruction following mastectomy (all p-values > 0.05). Conclusions: In patients with DCIS, the decision to pursue mastectomy appears to be driven by younger patient age and higher tumor grade. Younger patients are also more likely to opt for reconstruction following mastectomy.