Trends in treatment patterns and outcomes for DCIS patients: A SEER population-based analysis.

Worni, Mathias; Greenup, Rachel A.; Mackey, Aimee; Akushevich, Igor; Hwang, Shelley

doi:10.1200/jco.2014.32.15_suppl.1007

Cited by 6 publications

(8 citation statements)

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“…The proportion of women diagnosed with DCIS in the UK who do not undergo surgery is, therefore, unknown, but appears similar to the 2.0 -2.3% reported in the USA. [4,13] Because of the nature of the study population (with regard to patient age and associated comorbidities), many of the women died during the course of the study, substantially limiting the duration of follow-up. Furthermore, there were relatively few younger women with screen-detected disease.…”

Section: Discussionmentioning

confidence: 99%

“…However, some 2.0-2.3% of patients diagnosed with DCIS in the USA choose AS for management of their disease. [4,13] Without treatment, it has been estimated that only 20-30% of DCIS will progress to invasive cancer. [11,14] Furthermore, it is not known whether long-term disease outcome is adversely impacted by awaiting progression to invasive disease.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ

Maxwell

Clements

Hilton

et al. 2018

European Journal of Surgical Oncology

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High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ

Maxwell

Clements

Hilton

et al. 2018

European Journal of Surgical Oncology

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“…These options constitute GCC according to National Comprehensive Cancer Network treatment recommendations 7. Between 1991 and 2010, 23.8% of women diagnosed with DCIS in the USA underwent unilateral mastectomy (4.5% bilateral mastectomy), 43% lumpectomy with radiation and 26.5% lumpectomy without radiation 8. Published UK screening data suggest that in some cases, major surgical ‘cancer’ treatment of low-risk DCIS is unnecessary, inappropriate and misleading for the recipient 9.…”

Section: Introductionmentioning

confidence: 99%

“…7 Between 1991 and 2010, 23.8% of women diagnosed with DCIS in the USA underwent unilateral mastectomy (4.5% bilateral mastectomy), 43% lumpectomy with radiation and 26.5% lumpectomy without radiation. 8 Published UK screening data suggest that in some cases, major surgical ‘cancer’ treatment of low-risk DCIS is unnecessary, inappropriate and misleading for the recipient. 9 In those women who undergo surgical treatment for DCIS, there may be both short-term and long-term morbidities, including poor cosmesis and the risk of developing persistent pain at the surgical site, with estimates ranging from 25% to 68%.…”

Section: Introductionmentioning

confidence: 99%

The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS)

et al. 2019

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IntroductionDuctal carcinoma in situ (DCIS) is a non-invasive non-obligate precursor of invasive breast cancer. With guideline concordant care (GCC), DCIS outcomes are at least as favourable as some other early stage cancer types such as prostate cancer, for which active surveillance (AS) is a standard of care option. However, AS has not yet been tested in relation to DCIS. The goal of the COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial for low-risk DCIS is to gather evidence to help future patients consider the range of treatment choices for low-risk DCIS, from standard therapies to AS. The trial will determine whether there may be some women who do not substantially benefit from current GCC and who could thus be safely managed with AS. This protocol is version 5 (11 July 2018). Any future protocol amendments will be submitted to Quorum Centralised Institutional Review Board/local institutional review boards for approval via the sponsor of the study (Alliance Foundation Trials).Methods and analysisCOMET is a phase III, randomised controlled clinical trial for patients with low-risk DCIS. The primary outcome is ipsilateral invasive breast cancer rate in women undergoing GCC compared with AS. Secondary objectives will be to compare surgical, oncological and patient-reported outcomes. Patients randomised to the GCC group will undergo surgery as well as radiotherapy when appropriate; those in the AS group will be monitored closely with surgery only on identification of invasive breast cancer. Patients in both the GCC and AS groups will have the option of endocrine therapy. The total planned accrual goal is 1200 patients.Ethics and disseminationThe COMET trial will be subject to biannual formal review at the Alliance Foundation Data Safety Monitoring Board meetings. Interim analyses for futility/safety will be completed annually, with reporting following Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-inferiority trials.Trial registration numberNCT02926911; Pre-results.

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“…Currently published evidence indicates that patients generally favor a more aggressive approach to therapy, including consideration for contralateral prophylactic mastectomy even in the absence of increased risk of contralateral breast cancer. 6,24 There is support in the literature that this may be due to a lack of effective communication between provider and patient regarding the risks and benefits of more…”

Section: Discussionmentioning

confidence: 99%

Patient Preferences for Outcomes Following DCIS Management Strategies: A Discrete Choice Experiment

Chapman

Yang

Gonzalez

et al. 2021

JCO Oncology Practice

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PURPOSE: Ductal carcinoma in situ (DCIS), a nonobligate precursor of breast cancer, is often aggressively managed with multimodal therapy. However, there is limited research on patients' preferences for trade-offs among treatment-related outcomes such as breast appearance, side effects, and future cancer risk. We sought to investigate whether women consider treatment features aside from cancer risk when making treatment choices for ductal carcinoma in situ and if so, to what degree other features influence these decisions. METHODS: A discrete choice experiment was administered to participants in a comprehensive cancer screening mammography clinic. The experimental design was used to generate constructed health profiles resulting from different management strategies. Health profiles were defined by breast appearance, severity of infection within the first year, chronic pain, hot flashes, and risk of developing or dying from breast cancer within 10 years. RESULTS: One hundred ninety-four women without a personal history of breast cancer completed the choice task. Across 10 choice questions, 29% always selected the health profile with a lower risk of invasive breast cancer (ie, dominated on cancer risk), regardless of the effects of treatment. For nonrisk dominators, breast cancer risk remained the most important factor but was closely followed by chronic pain (24% [95% CI, 20 to 28]) and infection (22% [95% CI, 18 to 25]). Depending on treatment outcomes, the tolerable increase in breast cancer risk was as high as 3.4%. CONCLUSION: Most women were willing to make some trade-offs between invasive cancer risk and treatment-related outcomes. Our findings highlight the importance of shared decision-making weighing risks and benefits between patient and provider management of low-risk disease.

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Trends in treatment patterns and outcomes for DCIS patients: A SEER population-based analysis.

Cited by 6 publications

References 0 publications

Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ

Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ

The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS)

Patient Preferences for Outcomes Following DCIS Management Strategies: A Discrete Choice Experiment

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