Ductal carcinoma in situ: a brief review of treatment variation and impacts on patients and society.
Nearly 20% of all breast cancer cases are ductal carcinoma in situ (DCIS), with over 60,000 cases diagnosed each year. Many of these cases would never cause clinical symptoms or threaten the life of the woman; however, it is currently impossible to distinguish which lesions will progress to invasive disease from those that will not. DCIS is generally associated with an excellent prognosis regardless of the treatment pathway, but there is variation in treatment aggressiveness that seems to exceed the medical uncertainty associated with DCIS management. Therefore, it would seem that a significant proportion of women with DCIS receive more extensive treatment than is needed. This overtreatment of DCIS is a growing concern among the breast cancer community and has implications for both the patient (via adverse treatment-related effects, as well as out-of-pocket costs) and society (via economic costs and the public health and environmental harm resulting from health care delivery). This article discusses DCIS treatment pathways and their implications for patients and society and calls for further research to examine the factors that are leading to such wide variation in treatment decisions.
Rubenstein School of Environment and Natural Resources & College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont.
Christine
C
Vatovec
Department of Surgery, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont; Global Health Economics Unit of the Vermont Center for Clinical and Translational Science, University of Vermont, Burlington, Vermont.
Mujde Z
MZ
Erten
Department of Community Development and Applied Economics, University of Vermont, Burlington, Vermont.
Jane
J
Kolodinsky
Department of Sociology and Anthropology, Department of Health Sciences, Northeastern University, Boston, Massachusetts.
Phil
P
Brown
Department of Medicine, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont.
Marie
M
Wood
Department of Surgery, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont.
Ted
T
James
Department of Surgery, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont.
Brian L
BL
Sprague
D024221:Antineoplastic Protocols / Q000592:standards*; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans