Ductal carcinoma in situ patients overestimate breast cancer risks

Many women diagnosed with ductal carcinoma in situ (DCIS) have inaccurate perceptions of their breast cancer risks, according to a study published online February 12 in the Journal of the National Cancer Institute.

DCIS is a noninvasive precancer in which abnormal cells are found in the lining of a breast duct. Women with DCIS generally have a favorable prognosis—recurrence rates are low and only about one percent of DCIS patients die from breast cancer. Nonetheless, studies suggest that DCIS patients overestimate their risks of DCIS recurrence and developing invasive breast cancer.

Ann Partridge, M.D., and colleagues at Dana-Farber Cancer Institute in Boston investigated perceived breast cancer risks among women with newly diagnosed DCIS and how these risk perceptions were associated with anxiety and depression. They surveyed nearly 500 newly diagnosed DCIS patients about their quality of life (including depression and anxiety) and their perceived risk of recurrence or invasive breast cancer. The surveys were completed at enrollment in the trial and then again at 9 and 18 months.

At the time of enrollment, 10 percent of patients reported substantial anxiety, and two percent were depressed. Over time, anxiety levels decreased, and depression levels remained low. At enrollment, 54 percent of patients said they believed they were at least moderately likely to develop DCIS again within the next five years and 68 percent believed it was at least moderately likely to happen again at some point in their lifetime. Also, 28 percent of the women believed that it was at least moderately likely that DCIS would spread to other parts of their body. After 18 months, these perceptions had not changed substantially. Higher levels of anxiety were associated with an overestimation of future risks.

“Although women with DCIS appear to experience a reasonably favorable overall quality of life, some DCIS survivors may suffer from increased distress and poor mental health that may be related to inaccurate, increased perceptions of breast cancer risks. Clinicians who are caring for the increasing number of women who are diagnosed with DCIS should be aware of these inaccurate perceptions and attempt to minimize them,” the authors write.

In an accompanying editorial, H. Gilbert Welch, M.D., of the Department of Veterans Affairs Medical Center in White River Junction, Vt., and colleagues discuss the uncertainty surrounding a diagnosis of DCIS and the pitfalls of overdiagnosis and overtreatment. Since DCIS does not always progress to invasive cancer, it may be reasonable to promote active surveillance instead of performing surgery on every woman with DCIS, the editorialists note.

“Active surveillance could help women whose DCIS does not progress avoid treatment and allow those whose DCIS does progress to invasive cancer be diagnosed and treated when the prognosis is still extremely favorable,” they write.

But they acknowledge that active surveillance can not alleviate the effects of uncertainty and anxiety caused by the diagnosis of DCIS. To avoid these, they write, doctors should “question the value of making the diagnosis in the first place.” The editorialists suggest clinical trials be conducted to test a strategy of biopsying only those breast tumors that are large enough to be palpated (e.g., > 1 cm).