| Abstract: |
Key Points: Question: What factors are associated with surgery preference (wide local excision vs mastectomy) among a prospective cohort of women with newly diagnosed ductal carcinoma in situ (DCIS) before and after magnetic resonance imaging (MRI) and surgeon recommendation? Findings: In this cohort study of 368 women diagnosed with DCIS, surgical preference was statistically significantly associated with age and treatment goals and concerns before MRI receipt. Magnetic resonance imaging upstaging, surgeon recommendation, the self-reported importance of keeping one's breast, and cancer worry were associated with received surgery. Meaning: These findings suggest that surgery preference for women with DCIS may respond dynamically to additional diagnostic information conferred by MRI and surgeon recommendation. Importance: Guiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. Objective: To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. Design, Setting, and Participants: A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy. Exposures: Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. Main Outcomes and Measures: Patient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. Results: Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%] were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P =.007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P <.001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P =.03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR, 8.09; 95% CI, 2.51-26.06; P <.001). The 2 variables with the highest ORs for initial receipt of mastectomy were MRI upstaging (OR, 12.08; 95% CI, 4.34-33.61; P <.001) and surgeon recommendation (OR, 4.85; 95% CI, 1.99-11.83; P <.001). Conclusions and Relevance: In this cohort study, change in patient preference for DCIS surgery and surgery received were responsive to MRI results and surgeon recommendation. These data highlight the importance of ensuring adequate information and ongoing communication about the clinical significance of MRI findings and the benefits and risks of available treatment options. This cohort study examines the preferences of women for treatment of ductal carcinoma in situ on the basis of magnetic resonance imaging findings and surgeon recommendations. |
