Ductal Carcinoma In Situ Patients Often Mistake Risks


BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, clinicians caring for these patients should encourage them to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

In addition, future research should assess the impact of these risk misperceptions on patient outcome and health-related behaviors, she concluded.

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