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071 DCIS knowledge of women choosing between active surveillance and surgery for low-risk DCIS
  1. Ellen Engelhardt1,2,
  2. Renée Schmitz1,
  3. Miranda Gerritsma2,
  4. Carine Sondermeijer3,
  5. Ellen Verschuur4,
  6. Julia Houtzager2,
  7. Rosalie Griffioen2,
  8. Nina Bijker5,
  9. Ritse Mann6,7,
  10. Valesca Retèl2,
  11. Frederieke van Duijnhoven8,
  12. Jelle Wesseling1,9,10,
  13. Eveline Bleiker2,11
  1. 1Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  2. 2Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  3. 3Biometrics Department Netherlands Cancer Institute, Amsterdam, The Netherlands
  4. 4Borstkanker Vereniging Nederland, Utrecht, The Netherlands
  5. 5Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  6. 6Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  7. 7Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
  8. 8Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
  9. 9Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  10. 10Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
  11. 11Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands

Abstract

Introduction Ductal carcinoma in situ (DCIS) can progress to invasive breast cancer, but most low-risk lesions will not do so during a woman’s lifetime. It is not yet possible to accurately determine at diagnosis which lesions will progress if left untreated. Therefore, all DCIS patients undergo surgery with/without radiotherapy. To reduce overtreatment of low-risk DCIS, the safety of active surveillance via yearly mammographic screening is being investigated in the LORD patient preference trial (LORD-PPT). Women participating in the LORD-PPT are given a choice between surgery and active surveillance. Sufficient knowledge about DCIS is important for patients to make an informed choice. We assessed patients’ DCIS knowledge and its associations with socio-demographic and clinical characteristics.

Methods Women participating in the LORD-PPT completed a questionnaire assessing socio- demographic characteristics, perceived breast cancer risk and DCIS knowledge after being informed about their diagnosis and treatment options. Knowledge was assessed using a 7-item knowledge checklist. Descriptive statistics and non-parametric tests were performed.

Results 66% of the 376 participants correctly answered ≤3 questions in the knowledge questionnaire. Most incorrect answers related to false assumptions regarding safety of active surveillance and prognostic risks associated with a DCIS diagnosis. Women with higher DCIS knowledge scores perceived their risk of developing breast cancer as being somewhat higher than women with lower knowledge scores (p=0.005). Women with higher DCIS knowledge scores more often chose conventional treatment whilst most women with lower knowledge scores chose active surveillance (p=0.009). Education level was not associated with knowledge.

Discussion Overall, DCIS knowledge was poor and was associated with patients’ risk perception and treatment choice.

Conclusions Effective shared decision-making about DCIS treatment seems to regularly be lacking. Our findings underscore that there is a need for a patient decision aid and communication guides for clinicians to facilitate informed treatment decision-making for DCIS.

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