Lumpectomy followed by whole-breast radiation therapy (WBRT) provides a 50% recurrence rate-reduction in DCIS patients when compared to lumpectomy alone. Certain factors increase the risk of recurrence, including higher nuclear grade, large size, age less than 50, and close margins. RTOG 9804 demonstrated a reduction in local failure after WBRT with the use of adjuvant radiation in women with "good-risk disease" (mammographically detected, measuring less than or equal to 2.5 cm, with predominant nuclear grade of 1 or 2, and a margin of greater than or equal to 1 cm, or a negative re-excision). The purpose of this study is to retrospectively identify the patterns of care in women with low-risk DCIS utilizing the National Cancer Database. We hypothesize that with the utilization of hypofractionation, there may be an increase in delivery of RT for these "good-risk" patients.The National Cancer Database was queried to identify women treated with lumpectomy for a < 2.5 cm, nuclear grade 1 or 2 DCIS of the breast from 2004-2016. Data regarding age, tumor size, endocrine therapy use, ER receptor status, margin status, race, insurance type and distance from the treatment center were collected. Distance was stratified into quartiles consisting of 0-3.9, 4-8, 8.1-15.8, and > 15.8 miles respectively. Radiation fractionation was collected and categorized as hypofractionation, standard fractionation, or other, if fractionation could not be ascertained. Clinical and patient-related factors were compared between patients who received radiation and no radiation. Frequency distributions between categorical variables were compared using the Chi-square test. Multivariable logistic regression was used to identify covariables that impacted the receipt of radiation.A total of 13,313 patients met the eligibility criteria. Of those, 6,814 (51.2%) received adjuvant WBRT. On multivariable regression, patients whose tumors were ER- (OR 1.35, 95% CI 1.19-1.54, P < 0.001) and those who did not receive endocrine therapy (OR 2.34, 95% CI 1.94-2.95, P < 0.001) were more likely to receive WBRT. Factors less likely to receive WBRT included later year of diagnosis (OR 0.97, 95% CI 0.96-0.98, P < 0.001) increasing age over 50 (age 50-65 OR 0.84, P = 0.001; age > 65 OR 0.59, < 0.001), and distance of > 15.8 miles (OR 0.80, 95% CI 0.72-0.88, P < 0.001). Fractionation technique was categorized as standard or hypofractionated in 52.2% of patients. Of those, the use of hypofractionation increased from 0.4% in 2004 to 8.9% in 2010 and to 53.8% in 2016.This NCDB analysis demonstrated that patients who meet the RTOG 9804 criteria for "good-risk" DCIS are less likely to receive RT as time progresses despite an increase in utilization in hypofractionation techniques. Overall, slightly more than half of these patients receive adjuvant RT.