Partridge Ann, Winer Jeffrey P, Golshan Mehra, Bellon Jennifer R, Blood Emily, Dees E Claire, Sampson Ebonie, Emmons Karen M, Winer Eric
Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Clin Breast Cancer. 2008 Jun;8(3):275-80. doi: 10.3816/CBC.2008.n.032.
Limited previous data suggest that heterogeneity exists in the treatment approaches for women with ductal carcinoma in situ (DCIS). We sought in a longitudinal cohort study of women with DCIS to assess the attitudes and management approaches toward DCIS among physicians who provide care to women.
Eligible physicians were invited to participate in a 1-time mailed survey. A financial incentive and reminders were used to enhance the response rate. Physician perception of risks associated with DCIS for patients and management approaches were evaluated.
Two hundred and eight physicians were identified, and 151 (73%) completed the survey. Respondents had a median age of 49 years (range, 32-75 years), and most were surgeons or medical oncologists (66%). Eighty-eight percent reported seeing an average of >or= 1 new patient with DCIS per month. In a multivariable model, physicians who cared for proportionately fewer patients with breast cancer were more likely to view DCIS as a riskier disease to a patient's overall health compared with physicians who cared for more women with breast cancer (odds ratio, 2.2; 95% CI, 1.1-4.6; P = .036). Physicians exhibited differences in management approaches when considering theoretical patients with DCIS and did not use consistent terms when speaking with patients with DCIS.
Substantial variation exists among physicians regarding perceptions and management approaches for women with DCIS. In some settings, risks of physician-recommended therapy might outweigh benefits. Further evaluation of the effects of physician management approaches and attitudes about DCIS on patient outcomes is warranted.
既往有限的数据表明，导管原位癌（DCIS）女性患者的治疗方法存在异质性。我们在一项针对DCIS女性患者的纵向队列研究中，旨在评估为女性提供治疗的医生对DCIS的态度和管理方法。
邀请符合条件的医生参加一次邮寄调查。提供经济激励并发送提醒以提高回复率。评估医生对DCIS患者相关风险的认知以及管理方法。
确定了208名医生，151名（73%）完成了调查。受访者的中位年龄为49岁（范围32 - 75岁），大多数是外科医生或医学肿瘤学家（66%）。88%的医生报告每月平均接诊≥1例新的DCIS患者。在多变量模型中，与治疗更多乳腺癌女性患者的医生相比，治疗乳腺癌患者比例相对较少的医生更有可能认为DCIS对患者整体健康的风险更高（优势比为2.2；95%置信区间为1.1 - 4.6；P = 0.036）。在考虑DCIS的理论患者时，医生在管理方法上存在差异，并且在与DCIS患者交谈时使用的术语不一致。
医生对DCIS女性患者的认知和管理方法存在很大差异。在某些情况下，医生推荐治疗的风险可能超过益处。有必要进一步评估医生管理方法和对DCIS的态度对患者结局的影响。
