OBJECTIVES

Approximately 25% of breast cancer diagnoses detected with mammography represent ductal carcinoma in situ (DCIS), a non-invasive condition that is often aggressively managed with multimodal therapy. Management options may lower risk of invasive disease, but women encounter changes in breast appearance, treatment-associated risks and side effects. We aimed to quantify acceptable tradeoffs among features of alternative outcomes following various management options for DCIS.

METHODS

We designed and fielded a discrete-choice experiment survey among women presenting for screening mammography. The survey required women to complete 10 DCE choice questions representing 2 alternative health states defined by 5 attributes, each with 3 or 4 levels: breast appearance, severity of infection within the first year, years of chronic pain, years of hot flashes and risk of developing/dying from breast cancer within 10 years. Random-parameters logit models were used to fit the relationship between response options and attribute levels.

RESULTS

Nearly one-third (31%) of the 150 participants dominated on the risk of invasive disease, always selecting the option with the lowest cancer risk. Among the remaining women, on average, they would accept a 2.9% (95% CI: 1.9- 3.8) absolute 10-year risk of breast cancer to have a normal breast appearance compared to breast appearance after a mastectomy. Also, women would accept a 2.7% (95% CI: 1.9-3.6) risk of breast cancer to have a breast appearance following lumpectomy compared to mastectomy. There was variability in acceptable tradeoffs depending on surgical outcome, with tolerable breast cancer risk levels ranging from 2.2% to 3.5%.

CONCLUSIONS

The majority of participants (69%) found some increases in breast cancer risk acceptable to minimize changes in breast appearance following surgery. Clinicians treating women for DCIS should recognize that considerable heterogeneity exists in how women prioritize invasive cancer risk relative to breast appearance.