RESUMEN
BACKGROUND: Ductal carcinoma in situ (DCIS) represents 15% of all breast cancers in France. The first national survey was conducted in 2003. The present multi-center real-life practice survey aimed at assessing possible changes in demographic, clinical, pathologic, and treatment features. MATERIAL AND METHODS: From March 2014 to September 2015, patients diagnosed with DCIS from 71 centers with complete information about age, diagnostic features, and treatment modalities were prospectively included. RESULTS: A total of 2125 patients with a median age of 58.6 years from 71 centers were studied. DCIS was diagnosed by mammography in 87.5% of cases. Preoperative biopsy was performed in 96% of cases. The median tumor size was 15 mm. Nuclear grade was low, intermediate, and high in 12%, 36%, and 47% of cases, respectively. Margins were considered to be negative in 83% of cases. Overall mastectomy and lumpectomy rates were 25% and 75%, respectively. The immediate breast reconstruction rate was 50%. Sentinel node biopsy and axillary dissection rates were 41% and 2.6%, respectively. After lumpectomy, 97% of patients underwent radiotherapy, and 32% received a boost dose. Only 1% of patients received endocrine therapy. Compared with our previous survey, the median tumor size remained the same, and the proportion of high-grade lesions increased by 9%. The mastectomy rate decreased by 4%. CONCLUSIONS: The clinical practice identified in this survey complies with French DCIS guidelines. About 10% of patients with low-grade DCIS may be eligible to participate in treatment de-escalation trials.
Asunto(s)
Neoplasias de la Mama/terapia , Carcinoma Intraductal no Infiltrante/terapia , Adhesión a Directriz/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos Hormonales/normas , Antineoplásicos Hormonales/uso terapéutico , Biopsia/normas , Biopsia/estadística & datos numéricos , Mama/diagnóstico por imagen , Mama/patología , Mama/cirugía , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/diagnóstico , Carcinoma Intraductal no Infiltrante/epidemiología , Carcinoma Intraductal no Infiltrante/patología , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante/normas , Quimioterapia Adyuvante/estadística & datos numéricos , Femenino , Francia/epidemiología , Humanos , Mamoplastia/normas , Mamoplastia/estadística & datos numéricos , Mamografía/normas , Mamografía/estadística & datos numéricos , Mastectomía/métodos , Mastectomía/normas , Mastectomía/estadística & datos numéricos , Oncología Médica/normas , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Estudios Prospectivos , Radioterapia Adyuvante/métodos , Radioterapia Adyuvante/normas , Radioterapia Adyuvante/estadística & datos numéricos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
AIM: To evaluate the effectiveness of brief interventions (BIs) in reducing alcohol use among hazardous drinkers consulting their occupational doctors. DESIGN: Randomized controlled trial with 12-month follow-up, conducted between November 2004 and September 2006. SETTING: Fifteen French regional occupational medicine centers with 147 doctors and 157 assistants who were trained in BI and screening with the AUDIT questionnaire. PARTICIPANTS: We invited 33,488 individuals to fill out AUDIT. These patients were eligible if their scores were 6-12 for women and 7-12 for men, indicating hazardous drinking without dependence (found in 7.1% of respondents). INTERVENTION: After randomization, BIs (informative advice using motivational approach, with 10-minute average duration) were performed by the occupational doctors. The control group received information booklets from the doctors' assistants. MEASUREMENTS: Situations were evaluated 12 months after inclusion. OUTCOME MEASURES: AUDIT scores, self-reported alcohol consumption (SRAC) and biological assays. The main criteria were the differences observed between groups for SRAC, the AUDIT score at follow-up, and any reduction in score between inclusion and final assessment. Success of intervention, which was defined as an AUDIT score below the hazardous drinking threshold at follow-up, was considered to analyze the variables associated with the efficiency of intervention. RESULTS: The analyzed sample included 787 persons, among whom 435 were met again 12 months later. In the BI group, we found a lower AUDIT score (p = 0.01), a higher reduction in reported consumptions (-60 g/week versus -44 g/week, p = 0.04) and in AUDIT scores (p = 0.009). In the control group, 44.8% reduced their AUDIT scores below hazardous drinking thresholds, as compared to 51.6% in the BI group (p = 0.15). Success was associated with a significant reduction in biological and clinical indices. CONCLUSIONS: Though the high attrition rate led to careful conclusions, BIs seem to be efficient in occupational medicine, in comparison with written information, which also seems to influence drinking behavior.