Background. Although treatment of ductal carcinoma in situ (DCIS) is controversial, national guidelines recommend considering\nendocrine therapy for women with estrogen receptor- (ER-) positive DCIS or those undergoing breast conserving surgery (BCS)\nwithout radiation.We evaluated uptake and predictors of endocrine therapy use among older women with DCIS. Methods. In the\nSEER-Medicare database, we identified women aged 65+ years diagnosed withDCIS during 2007ââ?¬â??2011.We evaluated demographic,\ntumor, and treatment characteristics associated with endocrine therapy initiation. Results. Among 2,945 women with DCIS, 41%\ninitiated endocrine therapy (66% tamoxifen, 34% aromatase inhibitors). Initiation was more common among women with ERpositive\nthan ER-negative DCIS (48% versus 16%; HR = 3.75, 95% CI: 2.91ââ?¬â??4.83); 28% of women with unknown ER status initiated\nendocrine therapy. Initiation was less common after BCS alone compared to BCS with radiation (32% versus 50%; HR = 0.69, 95%\nCI: 0.59ââ?¬â??0.80). Conclusions. Less than half of older women with DCIS initiate endocrine therapy to prevent second breast cancers.\nOur findings suggest use was more common, but not exclusive, among women with ER-positive DCIS, but not among women who\nunderwent BCS alone. Endocrine therapy should be targeted toward patients most likely to benefit from its use.
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