Axillary evaluation and lymphedema in women with ductal carcinoma in situ

Ellie J. Coromilas, Jason D. Wright, Yongmei Huang, Sheldon M. Feldman, Alfred I. Neugut, Grace Clarke Hillyer, Ling Chen, Dawn L. Hershman

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65–90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 % of those treated with BCS and 69.4 % of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 % of women who had an axillary evaluation developed lymphedema, compared to 5.9 % of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 % CI 1.04–1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 % CI 0.40–1.74). Only 44 (0.40 %) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure.

Original languageEnglish (US)
Pages (from-to)373-384
Number of pages12
JournalBreast Cancer Research and Treatment
Volume158
Issue number2
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Fingerprint

Carcinoma, Intraductal, Noninfiltrating
Lymphedema
Mastectomy
Breast Neoplasms
Survival
Morbidity
Sentinel Lymph Node Biopsy
Segmental Mastectomy
Mortality
Incidence
Medicare
Proportional Hazards Models
Dissection
Cohort Studies
Retrospective Studies
Databases

Keywords

  • Axillary evaluation
  • Ductal carcinoma in situ
  • Lymphedema

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Coromilas, E. J., Wright, J. D., Huang, Y., Feldman, S. M., Neugut, A. I., Hillyer, G. C., ... Hershman, D. L. (2016). Axillary evaluation and lymphedema in women with ductal carcinoma in situ. Breast Cancer Research and Treatment, 158(2), 373-384. https://doi.org/10.1007/s10549-016-3890-0

Axillary evaluation and lymphedema in women with ductal carcinoma in situ. / Coromilas, Ellie J.; Wright, Jason D.; Huang, Yongmei; Feldman, Sheldon M.; Neugut, Alfred I.; Hillyer, Grace Clarke; Chen, Ling; Hershman, Dawn L.

In: Breast Cancer Research and Treatment, Vol. 158, No. 2, 01.07.2016, p. 373-384.

Research output: Contribution to journalArticle

Coromilas, EJ, Wright, JD, Huang, Y, Feldman, SM, Neugut, AI, Hillyer, GC, Chen, L & Hershman, DL 2016, 'Axillary evaluation and lymphedema in women with ductal carcinoma in situ', Breast Cancer Research and Treatment, vol. 158, no. 2, pp. 373-384. https://doi.org/10.1007/s10549-016-3890-0
Coromilas, Ellie J. ; Wright, Jason D. ; Huang, Yongmei ; Feldman, Sheldon M. ; Neugut, Alfred I. ; Hillyer, Grace Clarke ; Chen, Ling ; Hershman, Dawn L. / Axillary evaluation and lymphedema in women with ductal carcinoma in situ. In: Breast Cancer Research and Treatment. 2016 ; Vol. 158, No. 2. pp. 373-384.
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abstract = "Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65–90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 {\%} of those treated with BCS and 69.4 {\%} of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 {\%} of women who had an axillary evaluation developed lymphedema, compared to 5.9 {\%} of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 {\%} CI 1.04–1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 {\%} CI 0.40–1.74). Only 44 (0.40 {\%}) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure.",
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