DCIS patients overestimate breast cancer risks

http://www.hindu.com/thehindu/holnus...0802131541.htm
DCIS patients overestimate breast cancer risks

Many women diagnosed with ductal carcinoma in situ (DCIS) have inaccurate
perceptions of their breast cancer risks, according to a study published
online February 12 in the Journal of the National Cancer Institute.

DCIS is a noninvasive precancer in which abnormal cells are found in the
lining of a breast duct. Women with DCIS generally have a favorable
prognosis—recurrence rates are low and only about one percent of DCIS
patients die from breast cancer. Nonetheless, studies suggest that DCIS
patients overestimate their risks of DCIS recurrence and developing
invasive breast cancer, according to Eurekalert, the news service of the
American Association for the Advancement of Science.

Ann Partridge, M.D., and colleagues at Dana-Farber Cancer Institute in
Boston investigated perceived breast cancer risks among women with newly
diagnosed DCIS and how these risk perceptions were associated with anxiety
and depression. They surveyed nearly 500 newly diagnosed DCIS patients
about their quality of life (including depression and anxiety) and their
perceived risk of recurrence or invasive breast cancer. The surveys were
completed at enrollment in the trial and then again at 9 and 18 months.

At the time of enrollment, 10 percent of patients reported substantial
anxiety, and two percent were depressed. Over time, anxiety levels
decreased, and depression levels remained low. At enrollment, 54 percent
of patients said they believed they were at least moderately likely to
develop DCIS again within the next five years and 68 percent believed it
was at least moderately likely to happen again at some point in their
lifetime. Also, 28 percent of the women believed that it was at least
moderately likely that DCIS would spread to other parts of their body.
After 18 months, these perceptions had not changed substantially. Higher
levels of anxiety were associated with an overestimation of future risks.

“Although women with DCIS appear to experience a reasonably favorable
overall quality of life, some DCIS survivors may suffer from increased
distress and poor mental health that may be related to inaccurate,
increased perceptions of breast cancer risks. Clinicians who are caring
for the increasing number of women who are diagnosed with DCIS should be
aware of these inaccurate perceptions and attempt to minimize them,” the
authors write.

In an accompanying editorial, H. Gilbert Welch, M.D., of the Department of
Veterans Affairs Medical Center in White River Junction, Vt., and
colleagues discuss the uncertainty surrounding a diagnosis of DCIS and the
pitfalls of overdiagnosis and overtreatment. Since DCIS does not always
progress to invasive cancer, it may be reasonable to promote active
surveillance instead of performing surgery on every woman with DCIS, the
editorialists note.

“Active surveillance could help women whose DCIS does not progress avoid
treatment and allow those whose DCIS does progress to invasive cancer be
diagnosed and treated when the prognosis is still extremely favorable,”
they write.

But they acknowledge that active surveillance can not alleviate the
effects of uncertainty and anxiety caused by the diagnosis of DCIS. To
avoid these, they write, doctors should “question the value of making the
diagnosis in the first place.” The editorialists suggest clinical trials
be conducted to test a strategy of biopsying only those breast tumors that
are large enough to be palpated (e.g., > 1 cm).