A new study suggests that many women may be willing to face a small increase in risk of invasive disease rather than the side effects related to treatment of ductal carcinoma in situ (DCIS). Results of this study were reported in JCO Oncology Practice.
This study involved women who did not have a personal history of breast cancer completing a discrete choice experiment. The participants were recruited through a mammography screening clinic. The choice experiment required them to make 1 or more trade-offs between future risk of breast cancer and treatment-related side effects.
Prior to making their decision, participants were shown videos regarding the diagnosis and clinical significance of DCIS. They were then asked to choose between randomly developed health-profile scenarios involving treatment-related side effects and risk of developing or death from breast cancer within 10 years. A total of 80 unique choice tasks were created, and participants were each given 10 choice questions.
The choice task was completed by 194 participants. A minority of patients (29%) consistently chose health profiles associated with lower cancer risk. These patients’ responses reflected an unwillingness to experience increased cancer risk in the context of profiles presented in the choice experiment.
Factors of greatest importance to the participants in this study included risk of breast cancer (53%), chronic pain (19%), and infection (17%).
Patients who had chosen the lowest risk of breast cancer for at least 8 choice questions were categorized as risk dominators (57 patients). The remaining participants were considered nonrisk dominators (137 patients). Among the nonrisk dominators, breast cancer risk remained the most important factor (38%), followed by chronic pain (24%) and infection (22%).
Multiple acceptable tradeoffs were calculated for nonrisk dominators in terms of surgical procedures vs future cancer risk. These participants expressed a willingness to face a 3.4% absolute 10-year breast cancer risk if it meant no surgery, in comparison with mastectomy and reconstruction. An absolute risk of 1.0% was associated with trading lumpectomy for no surgery.
The study investigators pointed out that participants in this study did not have DCIS, so their perspectives may not reflect those following receipt of such a diagnosis.
“[U]sing a rigorous discrete choice experimental approach, we found that although some women are highly risk averse, the majority of women are willing to accept some increase in future breast cancer risk in exchange for reducing the extent of surgery or severity and/or duration of treatment-related side effects,” the researchers concluded.
Chapman BM, Yang JC, Gonzalez JM, Havrilesky L, Reed SD, Hwang ES. Patient preferences for outcomes following DCIS management strategies: a discrete choice experiment. JCO Oncol Pract. 2021;17(11):e1639-e1648. doi:10.1200/OP.20.00614