Abstract：
OBJECTIVE: Ductal-carcinoma in situ (DCIS) is a pre-invasive form of breast cancer with good prognosis. Follow-up guidelines in the Netherlands are currently the same as for invasive breast cancer. Due to fear of invasive breast cancer or recurrence, it is hypothesized that follow-up for DCIS after treatment is more intense in practice resulting in potentially unnecessary high costs. This study investigates the follow-up in practice for patients with DCIS compared to the recommendations in order to inform clinicians and policy makers how to utilize these guidelines.
METHODS: Patients diagnosed with pure DCIS between 2004 and 2014 were followed up until 2018. Information on duration and frequency of follow-up visits, reasons and decision makers for shortening, and prolonging follow-up was collected. Prolonged follow-up was defined as deviation from the Dutch guideline: more than 5 years of follow-up and older than 60 years.
RESULTS: Of the 227 patients the mean number of visits per year was 1.4 and mean years of follow-up was 6.0. Thirty-three percent had prolonged follow-up and 26% shorter follow-up than recommended. A majority (78%) of decision for prolonged follow-up was being made by clinicians.
CONCLUSIONS: Follow-up duration is in almost half of patients with DCIS according to guidelines and with most prolonged follow-up only up to a year longer than recommended. In most cases suspicious findings and the timing of the population screening program appeared to cause prolonged follow-up. If accepted by patients and clinicians, future DCIS specific guidelines should address these reasons and tailor to the individual risks.
METHODS: Patients diagnosed with pure DCIS between 2004 and 2014 were followed up until 2018. Information on duration and frequency of follow-up visits, reasons and decision makers for shortening, and prolonging follow-up was collected. Prolonged follow-up was defined as deviation from the Dutch guideline: more than 5 years of follow-up and older than 60 years.
RESULTS: Of the 227 patients the mean number of visits per year was 1.4 and mean years of follow-up was 6.0. Thirty-three percent had prolonged follow-up and 26% shorter follow-up than recommended. A majority (78%) of decision for prolonged follow-up was being made by clinicians.
CONCLUSIONS: Follow-up duration is in almost half of patients with DCIS according to guidelines and with most prolonged follow-up only up to a year longer than recommended. In most cases suspicious findings and the timing of the population screening program appeared to cause prolonged follow-up. If accepted by patients and clinicians, future DCIS specific guidelines should address these reasons and tailor to the individual risks.
摘要：
目的：导管原位癌（DCIS）是一种侵袭前的乳腺癌，预后良好。荷兰的后续指南目前与浸润性乳腺癌相同。由于害怕浸润性乳腺癌或复发，据推测,治疗后对DCIS的随访在实践中更为严格,从而导致潜在的不必要的高成本.本研究调查了与建议相比的DCIS患者的实践随访，以告知临床医生和政策制定者如何利用这些指南。
方法：对2004年至2014年间诊断为纯DCIS的患者进行随访，直至2018年。关于后续访问的持续时间和频率的信息，缩短的原因和决策者，并收集了延长的随访时间。长期随访被定义为偏离荷兰指南：随访超过5年，年龄超过60岁。
结果：在227例患者中，每年平均就诊次数为1.4次，平均随访时间为6.0年。33%的人延长了随访时间，比推荐时间短了26%。大多数（78％）的长期随访决定是由临床医生做出的。
结论：根据指南，几乎一半的DCIS患者的随访时间是随访时间，最长随访时间仅比推荐时间长一年。在大多数情况下，可疑的发现和人群筛查计划的时机似乎会导致长时间的随访。如果患者和临床医生接受，未来的DCIS特定指南应解决这些原因，并针对个人风险进行调整。
方法：对2004年至2014年间诊断为纯DCIS的患者进行随访，直至2018年。关于后续访问的持续时间和频率的信息，缩短的原因和决策者，并收集了延长的随访时间。长期随访被定义为偏离荷兰指南：随访超过5年，年龄超过60岁。
结果：在227例患者中，每年平均就诊次数为1.4次，平均随访时间为6.0年。33%的人延长了随访时间，比推荐时间短了26%。大多数（78％）的长期随访决定是由临床医生做出的。
结论：根据指南，几乎一半的DCIS患者的随访时间是随访时间，最长随访时间仅比推荐时间长一年。在大多数情况下，可疑的发现和人群筛查计划的时机似乎会导致长时间的随访。如果患者和临床医生接受，未来的DCIS特定指南应解决这些原因，并针对个人风险进行调整。
