Association Between Surgery Preference and Receipt in Ductal Carcinoma In Situ After Breast Magnetic Resonance Imaging: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112).

Autor:	Fazeli S; Department of Radiology, University of California San Diego, San Diego., Snyder BS; Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island., Gareen IF; Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island.; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island., Lehman CD; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston., Khan SA; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Romanoff J; Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island., Gatsonis CA; Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island., Corsetti RL; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana., Rahbar H; Department of Radiology, University of Washington, Seattle., Spell DW; Gulf South NCORP, New Orleans, Louisiana., Blankstein KB; Hunterdon Regional Cancer Center, Flemington, New Jersey., Han LK; Department of Surgery, Indiana University, Indianapolis., Sabol JL; Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania., Bumberry JR; Department of Surgery, Mercy Hospital Springfield, Springfield, Missouri., Miller KD; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis., Sparano JA; Department of Hematology-Oncology, Mount Sinai Health System, New York, New York., Comstock CE; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York., Wagner LI; Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina., Carlos RC; Department of Radiology, University of Michigan, Ann Arbor.; Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor.; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 May 02; Vol. 5 (5), pp. e2210331. Date of Electronic Publication: 2022 May 02.
DOI:	10.1001/jamanetworkopen.2022.10331
Abstrakt:	Importance: Guiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. Objective: To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. Design, Setting, and Participants: A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy. Exposures: Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. Main Outcomes and Measures: Patient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. Results: Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%] were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P = .007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P < .001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P = .03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR, 8.09; 95% CI, 2.51-26.06; P < .001). The 2 variables with the highest ORs for initial receipt of mastectomy were MRI upstaging (OR, 12.08; 95% CI, 4.34-33.61; P < .001) and surgeon recommendation (OR, 4.85; 95% CI, 1.99-11.83; P < .001). Conclusions and Relevance: In this cohort study, change in patient preference for DCIS surgery and surgery received were responsive to MRI results and surgeon recommendation. These data highlight the importance of ensuring adequate information and ongoing communication about the clinical significance of MRI findings and the benefits and risks of available treatment options.
Databáze:	MEDLINE
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