title: Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ.
abstract: OBJECTIVE
  Limited previous data suggest that heterogeneity exists in the treatment approaches for women with ductal carcinoma in situ (DCIS). We sought in a longitudinal cohort study of women with DCIS to assess the attitudes and management approaches toward DCIS among physicians who provide care to women.
  
  
  METHODS
  Eligible physicians were invited to participate in a 1-time mailed survey. A financial incentive and reminders were used to enhance the response rate. Physician perception of risks associated with DCIS for patients and management approaches were evaluated.
  
  
  RESULTS
  Two hundred and eight physicians were identified, and 151 (73%) completed the survey. Respondents had a median age of 49 years (range, 32-75 years), and most were surgeons or medical oncologists (66%). Eighty-eight percent reported seeing an average of >or= 1 new patient with DCIS per month. In a multivariable model, physicians who cared for proportionately fewer patients with breast cancer were more likely to view DCIS as a riskier disease to a patient's overall health compared with physicians who cared for more women with breast cancer (odds ratio, 2.2; 95% CI, 1.1-4.6; P = .036). Physicians exhibited differences in management approaches when considering theoretical patients with DCIS and did not use consistent terms when speaking with patients with DCIS.
  
  
  CONCLUSIONS
  Substantial variation exists among physicians regarding perceptions and management approaches for women with DCIS. In some settings, risks of physician-recommended therapy might outweigh benefits. Further evaluation of the effects of physician management approaches and attitudes about DCIS on patient outcomes is warranted.
authors.affiliation: Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. ahpartridge@partners.org
authors.forename: Ann
authors.initials: A
authors.lastname: Partridge
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Winer
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
authors.forename: Emily
authors.initials: E
authors.lastname: Blood
authors.forename: E Claire
authors.initials: EC
authors.lastname: Dees
authors.forename: Ebonie
authors.initials: E
authors.lastname: Sampson
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
authors.forename: Eric
authors.initials: E
authors.lastname: Winer
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000628:therapy*; D002278:Carcinoma in Situ / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010465:Perception; D010820:Physicians