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Background <p>Guideline concordant care (GCC) for ductal carcinoma in situ (DCIS) includes some combination of surgery, radiation, and/or endocrine treatment. Active monitoring (AM) is a common approach for high-risk breast histologies (e.g., atypical ductal hyperplasia [ADH] lobular intraepithelial neoplasias [LIN]) and has been proposed as an alternative to GCC for some low-risk DCIS. We compared patient-reported outcomes in women with DCIS who received GCC with those with other high-risk breast histologies in an active monitoring-proxy group (AM-P).</p> Methods <p>Women diagnosed with DCIS (GCC) or ADH/LIN (AM-P) from 2012 to 2017 at four cancer centers were surveyed regarding surgical-area pain, severity, and burden, generalized pain, anxiety, depression, and quality of life (QOL). The primary comparison was GCC versus AM-P. Multivariable logistic regression was used to model odds of reporting surgical-area pain. Multivariable marginal zero-inflated negative binomial models estimated mean scores and differences by group.</p> Results <p>A total of 912 women completed the survey (GCC, n = 538; AM-P, n = 374). At a median of 45.4 months following diagnosis, the AM-P group had lower odds of pain in the past month (0.35, 95% CI 0.25–0.49) and clinically significant pain (0.43, 95% CI 0.28–0.68). Adjusted mean pain severity index, surgical area sensory disturbance, pain-related cognitive/emotional impact scores were lower in the AM-P versus GCC group. Generalized pain, QOL, anxiety, and depressive symptoms were similar between groups.</p> Conclusions <p>Women with DCIS treated with GCC experienced more breast/chest wall pain than women in the AM-P group, although QOL was similar. Understanding these trade-offs can inform surgical de-escalation for high-risk lesions, including low-risk DCIS.</p>

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Patient-reported Outcomes After Routine Treatment of In Situ/Atypical Lesions: The PORTAL Study

  • 期刊论文

  • 发表日期：

    2025年7月27日

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  • Shoshana M. Rosenberg,
  • Christel Rushing,
  • Kristin L. Schreiber,
  • Kerri-Anne Crowell,
  • Isabelle Bedrosian,
  • Kevin S. Hughes,
  • Thomas Lynch,
  • Desiree Basila,
  • Deborah Collyar,
  • Elizabeth S. Frank,
  • Sonja Darai,
  • Conor Lanahan,
  • Jeffrey R. Marks,
  • Jennifer K. Plichta,
  • Terry Hyslop,
  • Alastair M. Thompson,
  • Ann H. Partridge,
  • E. Shelley Hwang

摘要

Background

Guideline concordant care (GCC) for ductal carcinoma in situ (DCIS) includes some combination of surgery, radiation, and/or endocrine treatment. Active monitoring (AM) is a common approach for high-risk breast histologies (e.g., atypical ductal hyperplasia [ADH] lobular intraepithelial neoplasias [LIN]) and has been proposed as an alternative to GCC for some low-risk DCIS. We compared patient-reported outcomes in women with DCIS who received GCC with those with other high-risk breast histologies in an active monitoring-proxy group (AM-P).

Methods

Women diagnosed with DCIS (GCC) or ADH/LIN (AM-P) from 2012 to 2017 at four cancer centers were surveyed regarding surgical-area pain, severity, and burden, generalized pain, anxiety, depression, and quality of life (QOL). The primary comparison was GCC versus AM-P. Multivariable logistic regression was used to model odds of reporting surgical-area pain. Multivariable marginal zero-inflated negative binomial models estimated mean scores and differences by group.

Results

A total of 912 women completed the survey (GCC, n = 538; AM-P, n = 374). At a median of 45.4 months following diagnosis, the AM-P group had lower odds of pain in the past month (0.35, 95% CI 0.25–0.49) and clinically significant pain (0.43, 95% CI 0.28–0.68). Adjusted mean pain severity index, surgical area sensory disturbance, pain-related cognitive/emotional impact scores were lower in the AM-P versus GCC group. Generalized pain, QOL, anxiety, and depressive symptoms were similar between groups.

Conclusions

Women with DCIS treated with GCC experienced more breast/chest wall pain than women in the AM-P group, although QOL was similar. Understanding these trade-offs can inform surgical de-escalation for high-risk lesions, including low-risk DCIS.