Project Description Narrative:
Ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer, accounts for approximately 25% of breast cancers diagnosed in women. Breast cancer is the most common non-skin cancer diagnosed in Wisconsin women. After surgery for DCIS when the entire area of concern is removed from the breast, surgical pathology reveals that approximately 10% of patients with DCIS actually have invasive breast cancer, which typically requires a sentinel lymph node biopsy (SLNB), a surgical procedure to remove several lymph nodes under the arm to determine if cancer has spread. However, between 5-10% of patients who undergo SLNB will develop lymphedema and/or injury to the nerves and blood vessels, which can be debilitating, disfiguring, and result in other long-term complications. Therefore, national consensus guidelines recommend that surgeons should not routinely perform SLNB for patients with DCIS undergoing breast conserving surgery (lumpectomy). If a patient is found to have invasive breast cancer after a lumpectomy for DCIS, SLNB can be performed at a second brief operation. Despite these recommendations, data from the Wisconsin Hospital Association from 2017-2022 found that over 14% of Wisconsin women who underwent lumpectomy for DCIS also received a SLNB at the time of their operation. Thus, a substantial number of Wisconsin women are unnecessarily undergoing SLNB and are being put at risk for long-term complications, such as lymphedema.
Through a synergetic partnership with the Surgical Collaborative of Wisconsin (SCW) and surgeons from the Medical College of Wisconsin and University of Wisconsin School of Medicine and Public Health, this project team aims to reduce the rate of SLNB in Wisconsin women undergoing lumpectomy for DCIS by 25%. The team will accomplish this by instituting surgeon-led statewide interactive in-person and online educational programs on the current indications for SLNB in women undergoing lumpectomy for DCIS, develop and distribute semi-annual benchmarked performance reports for individual surgeons and facilities on their rates of performing SLNB for DCIS patients undergoing lumpectomy, and then measure the effects that these interventions have on the statewide SLNB rates in women undergoing lumpectomy for DCIS.
Findings from this project will educate and engage Wisconsin surgeons, increase engagement and collegiality between surgeons who care for DCIS patients across Wisconsin, and most importantly, ensure all Wisconsin residents diagnosed with DCIS have access to high-quality modern surgical care for DCIS regardless of where they live or their access to fellowship/specialty-trained surgeons.