Journal of the National Cancer Institute Advance Access published online on February 12, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn010
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Risk Perceptions and Psychosocial Outcomes of Women With Ductal Carcinoma In Situ: Longitudinal Results From a Cohort Study
Affiliations of authors: Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (AP, KA, EB, CK, MG, JL, JSdM, JW, KE, EW); Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (ECD)
Correspondence to: Ann Partridge, MD, MPH, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 44 Binney St, Boston, MA 02115 (e-mail: ahpartridge{at}partners.org).
Background: Ductal carcinoma in situ (DCIS) has a generally favorable overall prognosis, with a systemic recurrence rate of approximately 1%, a local recurrence rate after mastectomy of 1%, and a local recurrence rate after breast-conserving treatment of less than 10%. Preliminary studies have suggested that women with DCIS may overestimate their risk of disease recurrence. Few data exist regarding psychosocial outcomes for women with DCIS.
Methods: Women in Eastern Massachusetts with newly diagnosed DCIS were asked to participate in a longitudinal study of risk perceptions, psychosocial concerns, and health behaviors. Psychosocial outcomes after DCIS diagnosis and risk perceptions were evaluated at enrollment and at 9 and 18 months. All statistical tests were two-sided.
Results: Four hundred eighty-seven women with DCIS (64% of eligible participants) completed the enrollment survey. Overall quality of life was good among the women surveyed, and the substantial anxiety at enrollment decreased with time (P < .001). At enrollment, 54% perceived at least a moderate risk for DCIS recurrence in the next 5 years, 68% in their lifetime; 39% perceived at least a moderate risk for invasive cancer in the next 5 years, 53% in their lifetime; and 28% perceived at least a moderate likelihood of DCIS spreading to other places in their body. At 18 months after enrollment, perceived risks had not statistically significantly changed from those at enrollment (P = .38). Anxiety at enrollment was the factor that was most consistently and strongly associated with overestimation of future breast cancer–related risks (perceived moderate or greater risk vs less than moderate risk of DCIS recurring within 5 years: odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.6 to 9.9, P = .003; of invasive breast cancer within 5 years: OR = 4.3, 95% CI = 1.9 to 9.9, P < .001; and of invasive breast cancer during lifetime: OR = 5.3, 95% CI = 2.0 to 14.3, P < .001).
Conclusions: Many women with newly diagnosed DCIS have inaccurate perceptions of the breast cancer risks that they face, and anxiety is particularly associated with these inaccurate perceptions.
| CONTEXT AND CAVEATS Prior knowledge Although women with ductal carcinoma in situ (DCIS) have good prognosis overall, studies have suggested that they overestimate their risks of DCIS recurrence and invasive breast cancer. Study design Quality of life, including risk perceptions and anxiety, of DCIS patients who underwent treatment was measured within 6 months of their diagnosis and again 9 months and 18 months later. Contribution Most women in the study overestimated their risks of DCIS recurrence and invasive breast cancer. Anxiety was consistently associated with these overestimated risk perceptions. Implication Future studies should investigate the impact of anxiety and overestimated perceptions of breast cancer risks on the treatment decisions of women with DCIS and test ways to reduce their anxiety and inaccurate risk perceptions. Limitations Nonresponder bias and the low proportion of older women in the study should be considered. Adjustment for multiple comparisons was not made, and because overestimation of risk was common in the study population the values of the odds ratios should not be taken as precise estimates of relative perceived risk.
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Manuscript received July 6, 2007; revised November 30, 2007; accepted January 9, 2008.
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J Natl Cancer Inst 2008 100: 228-229.
J Natl Cancer Inst 2008 100: 227.
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