Abstract Olutayo Sogunro1, Fatemeh Shojaeian1, Rebecca Marmor11 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: The Choosing Wisely (CW) campaign, initiated by the American Board of Internal Medicine, promotes evidence-based care by reducing unnecessary procedures and minimizing redundant clinical practices. In 2016, CW guidelines specific to breast oncology recommended that women over 70 years of age with small (≤2 cm), strongly hormone receptor-positive tumors and clinically negative axillary lymph nodes could safely omit both sentinel lymph node biopsy and whole breast radiation. In this study, we evaluate national trends in adherence to the omission of radiation therapy in patients with ductal carcinoma in situ (DCIS) and identify subgroup characteristics associated with compliance or non-compliance with these guidelines. Methods: Using the National Cancer Data Base (NCDB), we identified female patients, aged≥70 years, who were diagnosed with DCIS, pathologically T0, clinically node negative, hormone receptor positive, and had undergone surgical treatment between 2010 and 2021. Subgroup analysis evaluating Choosing Wisely compliance (CWC) in omission of radiation therapy (xRT) for patients 70 years or older was performed. Results: Our analysis of the NCDB resulted in a total of 57,132 patients. We divided the patients into Group 1- pre-CW (years 2010-2015) and Group 2- post-CW (years 2017-2021).Group 1 had a total of 24,658 patients and Group 2 had 32,474 patients. The average age was75 in both groups, and 84% and 81% of patients were White in Group 1 and 2, respectively. The Charlson-Deyo Score (CDS) was similar between the two groups with a score of zero for 79% of patients in Group 1 and 76% in Group 2. Eighty-seven percent of patients in each group were treated in metro areas. Fifty-one percent in both groups were classified as being treated in a community facility. In Group 1, 45% of patients had omission of radiation therapy compared to 50.3 % in Group 2. A multivariate logistic regression model analysis was performed to evaluate factors associated with a higher rate of CWC. Increased age (OR: 1.10, 95% CI 1.10-1.11, p0.001), CDS of 3 (OR:1.31, 95% CI 1.11-1.53, p = 0.001), and treatment at an academic facility (OR:1.20, 95% CI 1.12-1.28, p 0.001), were associated with higher CWC. The papillary and cribriform histological subtypes were significantly more likely to be compliant, (OR:1.77, 95% CI 1.55-2.02, p 0.001) and (OR:1.40, 95% CI 1.19-1.64 p 0.001), respectively. The comedo subtype was 31% less likely to be compliant (OR:0.69, 95% CI 0.55-0.87, p = 0.002) compared to the DCIS non otherwise specified subtype. Race and an urban versus rural setting did not have a significant impact on compliance. Conclusions: In this NCDB analysis of patients meeting Choosing Wisely (CW) eligibility criteria after 2017, 50.3% were compliant with the omission of radiation therapy. These findings highlight an opportunity to improve guideline implementation, particularly in non-academic settings. Ultimately, adherence to CW recommendations should be guided by shared decision-making between patients and physicians. Citation Format: O. Sogunro, F. Shojaeian, R. Marmor. Are we Choosing Wisely in the Omission of Radiation Therapy in Patients with Ductal Carcinoma In situ: A Review of Compliance Using the National Cancer Database abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-08-18.
Sogunro et al. (Tue,) studied this question.