Valuing preferences for treating screen detected ductal carcinoma in situ

Bromley, Hannah L.; Mann, G. Bruce; Petrie, Dennis; Nickson, Carolyn; Rea, Daniel; Roberts, Tracy

doi:10.1016/j.ejca.2019.09.026

Cited by 14 publications

(21 citation statements)

References 40 publications

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“…Treatment-related complications are further compounded by the emotional and economic toll that initial local treatment represents [5]. In a recent study on treatment preferences for screen-detected DCIS, patients valued active monitoring over standard interventional treatment [24]. This was largely influenced by the risk of progression: a 10% risk of progression at 10 Fig.…”

Section: Discussionmentioning

confidence: 99%

Treating (low-risk) DCIS patients: What can we learn from real-world cancer registry evidence?

Byng

Retèl

Schaapveld

et al. 2021

Breast Cancer Res Treat

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Purpose Results from active surveillance trials for ductal carcinoma in situ (DCIS) will not be available for > 10 years. A model based on real-world data (RWD) can demonstrate the comparative impact of non-intervention for women with low-risk features. Methods Multi-state models were developed using Surveillance, Epidemiology, and End Results Program (SEER) data for three treatment strategies (no local treatment, breast conserving surgery [BCS], BCS + radiotherapy [RT]), and for women with DCIS low-risk features. Eligible cases included women aged ≥ 40 years, diagnosed with primary DCIS between 1992 and 2016. Five mutually exclusive health states were modelled: DCIS, ipsilateral invasive breast cancer (iIBC) ≤ 5 years and > 5 years post-DCIS diagnosis, contralateral IBC, death preceded by and death not preceded by IBC. Propensity score-weighted Cox models assessed effects of treatment, age, diagnosis year, grade, ER status, and race. Results Data on n = 85,982 women were used. Increased risk of iIBC ≤ 5 years post-DCIS was demonstrated for ages 40–49 (Hazard ratio (HR) 1.86, 95% Confidence Interval (CI) 1.34–2.57 compared to age 50–69), grade 3 lesions (HR 1.42, 95%CI 1.05-1.91) compared to grade 2, lesion size ≥ 2 cm (HR 1.66, 95%CI 1.23–2.25), and Black race (HR 2.52, 95%CI 1.83–3.48 compared to White). According to the multi-state model, propensity score-matched women with low-risk features who had not died or experienced any subsequent breast event by 10 years, had a predicted probability of iIBC as first event of 3.02% for no local treatment, 1.66% for BCS, and 0.42% for BCS+RT. Conclusion RWD from the SEER registry showed that women with primary DCIS and low-risk features demonstrate minimal differences by treatment strategy in experiencing subsequent breast events. There may be opportunity to de-escalate treatment for certain women with low-risk features: Hispanic and non-Hispanic white women aged 50–69 at diagnosis, with ER+, grade 1 + 2, < 2 cm DCIS lesions.

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Section: Discussionmentioning

confidence: 99%

Treating (low-risk) DCIS patients: What can we learn from real-world cancer registry evidence?

Byng

Retèl

Schaapveld

et al. 2021

Breast Cancer Res Treat

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“…A previous measure of acceptability of active surveillance among women with low-risk screen-detected ductal carcinoma in situ similarly found that conservative alternatives are often less favoured as a result of anxiety surrounding diagnostic progression. 23 However, some reasons given for opting for surgery demonstrated a poor understanding of the information provided in the scenario, such as the assumption that CIN2 is cancer. This highlights the need for clinicians to clearly outline what CIN2 means and give evidence about the likelihood of progression into cancer.…”

Section: Discussionmentioning

confidence: 99%

Understanding women’s choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study

Keers

Yamada

Pickles

et al. 2021

Aust NZ J Obst Gynaeco

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Background: Active surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment. Aim: To determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2. Materials and Methods: Women residing in Australia aged 25-40 years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)-positive: high-grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free-text reason/s for their choice were thematically analysed.Results: Of the 1638 women randomised, 79% (n = 1293) opted for active surveillance. The most common reasons for choosing active surveillance included concerns about surgery and associated risks, preferring to 'wait and see', trusting the doctor's recommendations and having an emotional response toward surgery. For women who chose surgery, being risk-averse, addressing the issue straight away and perceiving surgery to be the better option for them were the most common themes identified. Conclusion:When presented with balanced information on the benefits and harms of different management options for CIN2 and given a choice, most women in this hypothetical situation chose active surveillance over surgery. Addressing women's concerns about active surveillance may open up the possibility that if deemed safe, it could be an acceptable alternative for women.

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“…None of our participants were supportive of this option. Other studies, one involving women with DCIS and another using a hypothetical scenario about DCIS, have reported a more positive attitude towards watchful waiting amongst Australian women [16,31]. .…”

Section: …" [Participant 16]mentioning

confidence: 97%

“…Participants were interviewed about their DCIS diagnosis, treatment and decision making processes. Questions were developed based on our study aim and the work of Bromley [16] (Supplementary Table 2). At the beginning of each interview the participant confirmed verbal consent to the interview.…”

Section: Interviewsmentioning

confidence: 99%

Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study

et al. 2021

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Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment.The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them.

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Valuing preferences for treating screen detected ductal carcinoma in situ

Cited by 14 publications

References 40 publications

Treating (low-risk) DCIS patients: What can we learn from real-world cancer registry evidence?

Treating (low-risk) DCIS patients: What can we learn from real-world cancer registry evidence?

Understanding women’s choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study

Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study

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