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Evaluation of Long-Term Satisfaction with Breast Surgery in Patients Treated for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast-conserving surgery (BCS) and mastectomy have equivalent survival for ductal carcinoma in situ (DCIS), allowing patients to participate in selecting a personalized surgical option; however, this decision-making role can increase patient anxiety. Data evaluating patient satisfaction with their decision to undergo BCS versus mastectomy for the treatment of DCIS are limited.

Methods

Women with DCIS were enrolled in a population-based, state-wide cohort from 1997 to 2006. Participants were surveyed about their satisfaction with their surgical and reconstruction decisions. Quality-of-life (QoL) evaluations were performed with biennial follow-up surveys though 2016. Multivariable logistic regression modeling examined the relationship between type of surgery and reconstruction with patient satisfaction.

Results

Overall, 1537 women were surveyed, on average, 2.9 years following DCIS diagnosis. Over 90% reported satisfaction with their treatment decision regardless of surgery type. Women who underwent mastectomy with reconstruction were more likely to report lower levels of satisfaction than women who underwent BCS (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.18–7.51, p < 0.01). However, over 80% of women who underwent mastectomies reported satisfaction with their reconstruction decision. Women without reconstruction had the highest levels of satisfaction, while women with implants were more likely to be dissatisfied (implant + autologous: OR 2.77, 95% CI 1.24–6.24; implant alone: OR 4.02, 95% CI 1.947–8.34, p ≤ 0.01). QoL scores were not associated with differences in surgical or reconstruction satisfaction at 5, 10, and 15 years following DCIS diagnosis.

Conclusions

Women undergoing surgery for DCIS express satisfaction with their treatment decisions. Following mastectomy, most women are satisfied with their reconstruction decision, including women who did not undergo reconstruction.

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Acknowledgments

The authors would like to thank Drs. Brian Sprague, Andreas Friedl, Hazel Nichols, and Elizabeth Burnside, as well as Julie McGregor, Kathy Peck, Hollis Moore, Oyewale Shiyanbola, and Laura Stephenson, for their contributions to study design and data collection.

Disclosures

Lee G. Wilke is a founder and minority stock owner of Elucent Medical. Devon Livingston-Rosanoff is supported by National Institutes of Health Surgical Oncology training Grant (T32 CA090217) and the American College of Surgeons Resident Research Scholarship. This study was also supported by Grants from the National Cancer Institute (P30 CA014520, R01 CA067264, P20 GM103644). Portions of this study were presented at the Clinical Congress in Boston, MA, USA, in October 2018.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Devon Livingston-Rosanoff MD, PhD & Lee G. Wilke MD

  2. Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Amy Trentham-Dietz PhD & John M. Hampton MS

  3. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Polly A. Newcomb PhD

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  1. Devon Livingston-Rosanoff MD, PhD
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  2. Amy Trentham-Dietz PhD
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  5. Lee G. Wilke MD
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Correspondence to Devon Livingston-Rosanoff MD, PhD.

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Livingston-Rosanoff, D., Trentham-Dietz, A., Hampton, J.M. et al. Evaluation of Long-Term Satisfaction with Breast Surgery in Patients Treated for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study. Ann Surg Oncol 27, 2628–2636 (2020). https://doi.org/10.1245/s10434-020-08216-z

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