Years later, DCIS tied to more imaging but not anxiety

By Theresa Pablos, AuntMinnie staff writer

May 26, 2020 -- In the five years after treatment, women with a history of ductal carcinoma in situ (DCIS) are more likely than their peers to undergo breast imaging but not to have anxiety or depression, according to the findings of a study published on May 8 in Breast Cancer Research and Treatment.

The results come from a large, long-term study of all women in Ontario with a DCIS diagnosis from 2010 through 2015. The findings suggest that women with a DCIS diagnosis don't necessarily have worse long-term psychological outcomes, even when they undergo additional breast-related procedures.

"We did not observe an increase in physician visits related to anxiety or depression diagnosis codes or in visits to a psychiatrist, overall or among strata defined by age and treatment by [breast conserving surgery] with or without [radiation treatment] or by mastectomy," wrote the authors, led by Dr. Lawrence Paszat, an associate professor of radiology oncology at the University of Toronto Sunnybrook Research Institute.

Previous research has shown that women with a DCIS diagnosis may initially experience an increase in anxiety, depression, and fear of recurrence, but it's not known whether these feelings persist years later.

For their study, the authors parsed electronic health records data for all female patients in Ontario, Canada, with a unilateral DCIS diagnosis between 2010 and 2015. The study population neither had a history of breast cancer nor did they develop invasive cancer in the six months after diagnosis.

The authors matched each woman with DICS to five controls without a history of cancer based on their birth year, mammography utilization, household income, and urban/rural location for a total study population of 4,979 women. They then compared health utilization data for the two groups of women one to four years after DCIS diagnosis.

Breast-related health services utilization for women with a prior DCIS diagnosis
Service Risk ratio compared with peers without cancer
Mammography 1.24
Breast ultrasound 2.02
Breast MRI 2.5
Breast biopsy 2.28
Outpatient hospital breast procedure 7.87
Inpatient hospital breast procedure 54.16

Women with DCIS were more likely than their peers to receive numerous breast imaging procedures, including screening mammography, breast ultrasound, and breast MRI. They were also much more likely to undergo a breast biopsy or hospital-based breast surgery procedure.

The increase in breast procedures and imaging largely stemmed from routine surveillance of women who underwent breast-conserving surgery with or without radiation treatment, the authors noted. The hospital-based procedures included postmastectomy reconstruction, mastectomy or breast-conserving surgery without evidence of disease, breast augmentation, and breast reduction.

Women with a history of DCIS were also slightly more likely than their peers to visit the emergency department, have an outpatient gynecologic procedure, and to visit a primary care provider. Despite increases for some types of care, women with prior DCIS were no more likely than their peers to have a diagnostic code related to anxiety or depression or to have visited a psychiatrist one to four years after DCIS diagnosis.

The authors cautioned that they couldn't match DCIS to peers based on some known breast cancer risk factors, including a family history of breast cancer, mammographic density, the use of hormone replacement therapy, and reproductive history. Nevertheless, the findings may reassure patients and their care teams worried about long-term mental health risks following DCIS diagnosis.

"Patients and their surgeons and physicians can be reassured by the absence of an increase in the rate of nonbreast-related procedures among cases overall ... and by the absence of an increase in physician or emergency room visits or anxiety and depression diagnostic codes," the authors concluded.


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