{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:20:26Z","timestamp":1787242826877,"version":"build-2736575974"},"reference-count":44,"publisher":"Elsevier BV","issue":"3","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinical-breast-cancer.com","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Clinical Breast Cancer"],"published-print":{"date-parts":[[2021,6]]},"DOI":"10.1016\/j.clbc.2020.10.007","type":"journal-article","created":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T19:18:06Z","timestamp":1603567086000},"page":"e271-e278","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"title":["Cost-Effectiveness Analysis of Biological Signature DCISionRT Use for DCIS Treatment"],"prefix":"10.1016","volume":"21","author":[{"given":"Hayeon","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1502-6484","authenticated-orcid":false,"given":"John A.","family":"Vargo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushil","family":"Beriwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.clbc.2020.10.007_bib1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/jncimonographs\/lgq027","article-title":"Epidemiology of ductal carcinoma in site","volume":"41","author":"Kerlikowske","year":"2010","journal-title":"J\u00a0Natl Cancer Inst Monogr"},{"key":"10.1016\/j.clbc.2020.10.007_bib2","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/jnci\/djr027","article-title":"Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS","volume":"103","author":"Wapnir","year":"2011","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.clbc.2020.10.007_bib3","doi-asserted-by":"crossref","first-page":"3938","DOI":"10.1200\/JCO.2015.60.8588","article-title":"Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study","volume":"33","author":"Solin","year":"2015","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib4","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1200\/JCO.2014.57.9029","article-title":"RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation","volume":"33","author":"McCormick","year":"2015","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib5","doi-asserted-by":"crossref","first-page":"e181100","DOI":"10.1001\/jamanetworkopen.2018.1100","article-title":"Association of radiotherapy with survival in women treated for ductal carcinoma in situ with lumpectomy or mastectomy","volume":"1","author":"Giannakeas","year":"2018","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.clbc.2020.10.007_bib6","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/jnci\/djt067","article-title":"A\u00a0multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast","volume":"105","author":"Solin","year":"2013","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.clbc.2020.10.007_bib7","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s10549-018-4693-2","article-title":"Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies","volume":"169","author":"Rakovitch","year":"2018","journal-title":"Breast Cancer Res Treat"},{"key":"10.1016\/j.clbc.2020.10.007_bib8","doi-asserted-by":"crossref","first-page":"3282","DOI":"10.1245\/s10434-019-07537-y","article-title":"Comparison of local recurrence risk estimates after breast-conserving surgery for DCIS: DCISNomogram versus refined Oncotype DX breast DCIS score","volume":"26","author":"Van Zee","year":"2019","journal-title":"Ann Surg Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib9","doi-asserted-by":"crossref","first-page":"275","DOI":"10.3816\/CBC.2008.n.032","article-title":"Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ","volume":"8","author":"Partridge","year":"2008","journal-title":"Clin Breast Cancer"},{"key":"10.1016\/j.clbc.2020.10.007_bib10","doi-asserted-by":"crossref","first-page":"3963","DOI":"10.1200\/JCO.2016.67.8532","article-title":"Cost effectiveness of the Oncotype DX DCIS score for guiding treatment of patients with ductal carcinoma in situ","volume":"34","author":"Raldow","year":"2016","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib11","doi-asserted-by":"crossref","first-page":"5895","DOI":"10.1158\/1078-0432.CCR-18-0842","article-title":"A\u00a0biologic signature for breast ductal carcinoma in situ to predict radiation therapy benefit and assess recurrence risk","volume":"24","author":"Bremer","year":"2018","journal-title":"Clin Cancer Res"},{"issue":"suppl","key":"10.1016\/j.clbc.2020.10.007_bib12","doi-asserted-by":"crossref","first-page":"GS5-08","DOI":"10.1158\/1538-7445.SABCS17-GS5-08","article-title":"A\u00a0validation of DCIS biological risk profile in a randomized study for radiation therapy with 20-year follow-up (SweDCIS)","volume":"4","author":"W\u00e4rnberg","year":"2018","journal-title":"Cancer Res"},{"issue":"15 suppl","key":"10.1016\/j.clbc.2020.10.007_bib13","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1200\/JCO.2019.37.15_suppl.568","article-title":"Risk stratification in early stage luminal breast cancer patients treated with and without RT","volume":"37","author":"Wadsten","year":"2019","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib14","doi-asserted-by":"crossref","DOI":"10.1158\/1078-0432.CCR-19-1152","article-title":"Validation of a ductal carcinoma in situ biomarker profile for risk of recurrence after breast-conserving surgery with and without radiation therapy","author":"Weinmann","year":"2020","journal-title":"Clin Cancer Res"},{"key":"10.1016\/j.clbc.2020.10.007_bib15","author":"Whitworth"},{"key":"10.1016\/j.clbc.2020.10.007_bib16","author":"Shivers"},{"key":"10.1016\/j.clbc.2020.10.007_bib17","article-title":"Comments in response to the center for Medicare and Medicaid Innovation oncology care model","author":"Thervenot","year":"2015","journal-title":"ASTRO"},{"key":"10.1016\/j.clbc.2020.10.007_bib18","doi-asserted-by":"crossref","first-page":"f1049","DOI":"10.1136\/bmj.f1049","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement","volume":"346","author":"Husereau","year":"2013","journal-title":"BMJ"},{"key":"10.1016\/j.clbc.2020.10.007_bib21","doi-asserted-by":"crossref","first-page":"4054","DOI":"10.1200\/JCO.2013.49.5077","article-title":"Breast conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial","volume":"31","author":"Donker","year":"2013","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib22","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1093\/jncimonographs\/lgq039","article-title":"Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast","volume":"2010","author":"Correa","year":"2010","journal-title":"J\u00a0Natl Cancer Inst Monogr"},{"key":"10.1016\/j.clbc.2020.10.007_bib23","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1001\/jamaoncol.2016.6948","article-title":"Association of radiotherapy boost for ductal carcinoma in situ with local control after whole-breast radiotherapy","volume":"3","author":"Moran","year":"2017","journal-title":"JAMA Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib24","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1200\/JCO.1997.15.3.1252","article-title":"Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer","volume":"15","author":"Hayman","year":"1997","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib25","doi-asserted-by":"crossref","first-page":"5171","DOI":"10.1200\/JCO.2005.11.692","article-title":"Assessing the benefit of radiation therapy after breast- conserving surgery for ductal carcinoma-in-situ","volume":"23","author":"Hayman","year":"2005","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib26","article-title":"Effectiveness of breast-conserving surgery and 3-dimensional conformal partial breast reirradiation for recurrence of breast cancer in the ipsilateral breast: the NRG Oncology\/RTOG 1014 phase 2 clinical trial","author":"Arthur","year":"2019","journal-title":"JAMA Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib27","first-page":"CD000563","article-title":"Post-operative radiotherapy for ductal carcinoma in situ of the breast","volume":"11","author":"Goodwin","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.clbc.2020.10.007_bib28","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1002\/cncr.20886","article-title":"Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast","volume":"103","author":"Solin","year":"2005","journal-title":"Cancer"},{"key":"10.1016\/j.clbc.2020.10.007_bib29","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/MLR.0b013e31815c31a7","article-title":"What does the value of modern medicine say about the $50,000 per quality-adjusted life year decision rule?","volume":"46","author":"Braithwaite","year":"2008","journal-title":"Med Care"},{"key":"10.1016\/j.clbc.2020.10.007_bib30","unstructured":"Drummond MF, Sculpher MJ, Torrance GW, et\u00a0al. Methods for Economic Evaluation of Health Care Programmes. 3rd ed. Oxford: Oxford University Press."},{"key":"10.1016\/j.clbc.2020.10.007_bib31","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1002\/hec.1481","article-title":"International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?","volume":"19","author":"Shiroiwa","year":"2010","journal-title":"Health Econ"},{"key":"10.1016\/j.clbc.2020.10.007_bib32","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1177\/027298902400448867","article-title":"Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease","volume":"22","author":"Briggs","year":"2002","journal-title":"Med Decis Making"},{"key":"10.1016\/j.clbc.2020.10.007_bib33","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13058-016-0705-5","article-title":"The distribution of ductal carcinoma in situ (DCIS) grade in 4232 women and its impact on overdiagnosis in breast cancer screening","volume":"18","author":"Van Luijt","year":"2016","journal-title":"Breast Cancer Res"},{"issue":"15 suppl","key":"10.1016\/j.clbc.2020.10.007_bib34","doi-asserted-by":"crossref","first-page":"6647","DOI":"10.1200\/JCO.2019.37.15_suppl.6647","article-title":"National cancer expenditure analysis in the United States Medicare population, 2013","volume":"37","author":"Ruiz","year":"2019","journal-title":"J\u00a0Clin Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib36","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1002\/cncr.20580","article-title":"The management of ductal carcinoma in situ in North America and Europe. Results of a survey","volume":"101","author":"Ceilley","year":"2004","journal-title":"Cancer"},{"key":"10.1016\/j.clbc.2020.10.007_bib37","doi-asserted-by":"crossref","first-page":"2810","DOI":"10.1002\/cncr.30105","article-title":"Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ","volume":"122","author":"Shiyanbola","year":"2016","journal-title":"Cancer"},{"key":"10.1016\/j.clbc.2020.10.007_bib38","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/jnci\/djh069","article-title":"Trends in the treatment of ductal carcinoma in situ of the breast","volume":"96","author":"Baxter","year":"2004","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.clbc.2020.10.007_bib39","doi-asserted-by":"crossref","first-page":"djv263","DOI":"10.1093\/jnci\/djv263","article-title":"Trends in treatment patterns and outcomes for ductal carcinoma in situ","volume":"107","author":"Worni","year":"2015","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.clbc.2020.10.007_bib40","doi-asserted-by":"crossref","first-page":"pkaa004","DOI":"10.1093\/jncics\/pkaa004","article-title":"Cost effectiveness of DCISionRT for guiding treatment of ductal carcinoma in situ","volume":"4","author":"Raldow","year":"2020","journal-title":"JNCI Cancer Spectr"},{"key":"10.1016\/j.clbc.2020.10.007_bib41","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jval.2015.02.001","article-title":"Cost-effectiveness analysis alongside clinical trials\u2014an ISPOR Good Research Practices Task Force report","volume":"18","author":"Ramsey","year":"2015","journal-title":"Value Health"},{"key":"10.1016\/j.clbc.2020.10.007_bib42","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1524-4733.2009.00660.x","article-title":"Good research practices for measuring drug costs in cost-effectiveness analyses: a societal perspective. The ISPOR Drug Cost Task Force Report, part 2","volume":"13","author":"Garrison","year":"2010","journal-title":"Value Health"},{"key":"10.1016\/j.clbc.2020.10.007_bib43","author":"Gupta"},{"key":"10.1016\/j.clbc.2020.10.007_bib44","doi-asserted-by":"crossref","first-page":"djx068","DOI":"10.1093\/jnci\/djx068","article-title":"Cost-effectiveness analysis comparing conventional, hypofractionated, and intraoperative radiotherapy for early-stage breast cancer","volume":"109","author":"Deshmukh","year":"2017","journal-title":"J\u00a0Natl Cancer Inst"},{"key":"10.1016\/j.clbc.2020.10.007_bib45","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.prro.2018.01.012","article-title":"Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline","volume":"8","author":"Smith","year":"2018","journal-title":"Pract Radiat Oncol"},{"key":"10.1016\/j.clbc.2020.10.007_bib46","doi-asserted-by":"crossref","first-page":"2542","DOI":"10.1001\/jama.2014.16616","article-title":"Uptake and costs of hypofractionated vs. conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013","volume":"312","author":"Bekelman","year":"2014","journal-title":"JAMA"},{"key":"10.1016\/j.clbc.2020.10.007_bib47","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1002\/1097-0142(20010315)91:6<1090::AID-CNCR1104>3.0.CO;2-D","article-title":"Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast","volume":"91","author":"Solin","year":"2001","journal-title":"Cancer"}],"container-title":["Clinical Breast Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1526820920302664?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1526820920302664?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:21:32Z","timestamp":1761513692000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1526820920302664"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":44,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["S1526820920302664"],"URL":"https:\/\/doi.org\/10.1016\/j.clbc.2020.10.007","relation":{},"ISSN":["1526-8209"],"issn-type":[{"value":"1526-8209","type":"print"}],"subject":[],"published":{"date-parts":[[2021,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Cost-Effectiveness Analysis of Biological Signature DCISionRT Use for DCIS Treatment","name":"articletitle","label":"Article Title"},{"value":"Clinical Breast Cancer","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.clbc.2020.10.007","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}