Trends in lobular carcinoma in situ management: endocrine therapy use in California and New Jersey
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The diagnosis of lobular carcinoma in situ (LCIS) is a strong risk factor for breast cancer. Endocrine therapy (ET) for LCIS has been shown to decrease breast cancer risk substantially. The purpose of this study was to evaluate the trends of ET use for LCIS in two large geographic locations.
Patients and methods
We identified women, ages 18 through 75, with a microscopic diagnosis of LCIS in California (CA) and New Jersey (NJ) from 2004 to 2014. We evaluated trends in unadjusted ET rates during the study period and used logistic regression to evaluate the relationship between patient, tumor, and treatment characteristics, and ET use.
We identified 3,129 patients in CA and 2,965 patients in NJ. The overall use of ET during the study period was 14%. For the combined sample, women in NJ were significantly less likely to utilize ET then their counterparts in CA (OR 0.77, CI 0.66–0.90, NJ vs. CA). In addition, patients in the later year period (OR 1.27, CI 1.01–1.59, 2012–2014 vs. 2004–2005) and women who received an excisional biopsy (OR 2.35, CI 1.74–3.17), were more likely to utilize ET. Uninsured women were less likely to receive ET (OR 0.61, CI 0.44–0.84, non-insured vs. insured status).
We observed that an increasing proportion of women are using ET for LCIS management, but geographical differences exist. Health insurance status played an important role in the underutilization of ET. Further research is needed to assess patient outcomes given the variations in management of LCIS.
KeywordsLCIS Endocrine therapy (ET) Geographic variation
We thank Antoinette M. Stroup, Ph.D., Director of the New Jersey State Cancer Registry for her assistance in reviewing this manuscript. We also thank the California Cancer Registry; the New Jersey State Cancer Registry, Cancer Epidemiology Services; New Jersey Department of Health, which is funded by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute under Contract HHSN261201300021I; the National Program of Cancer Registries (NPCR); Centers for Disease Control and Prevention under Grant 5U58DP003931-02 as well as the State of New Jersey and the Rutgers Cancer Institute of New Jersey.
SM: Conceptualization, methodology, validation, formal analysis, investigation, data curation, writing-original draft, visualization. Bonnie J-D’E: Conceptualization, investigation, resources, data curation, writing-original draft, visualization. JB: Validation, visualization, and writing-review and editing. JYCH: Conceptualization, writing-review and editing, and visualization. AA: Validation, visualization, and writing-review and editing. SK: Validation, visualization, and writing-review and editing. TMT: Conceptualization, methodology, validation, writing-original draft, writing-review and editing, supervision, project administration, resources, and visualization.
This publication was supported by the Grant or Cooperative Agreement Number, NU58DP006279, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Compliance with ethical standards
Conflict of interest
The authors of this manuscript have no conflicts of interest to disclose.
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