Ductal Carcinoma In Situ Biology, Language, and Active Surveillance: A Survey of Breast Radiologists' Knowledge and Opinions.
Ontology highlight
ABSTRACT: Purpose
To understand how breast radiologists perceive ductal carcinoma in situ (DCIS).Materials and methods
A 19-item survey was developed by the Society of Breast Imaging Patient Care and Delivery Committee and distributed to all Society of Breast Imaging members. The survey queried respondents' demographics, knowledge of DCIS biology, language used to discuss a new diagnosis of DCIS, and perspectives on active surveillance for DCIS. Five-point Likert scales (1 = strongly disagree, 3 = neutral, 5 = strongly agree) were used.Results
There were 536 responses for a response rate of 41%. There was agreement that DCIS is the primary driver of overdiagnosis in breast cancer screening (median 4), and respondents provided mean and median overdiagnosis estimates of 29.7% and 25% for low-grade DCIS as well as 4.2% and 0% for high-grade DCIS, respectively. Responses varied in how to describe DCIS but most often used the word "cancer" with a qualifier such as "early" (32%) or "pre-invasive" (25%). Respondents disagreed (median 2) with removing the word "carcinoma" from DCIS. Finally, there was agreement that current standard of care therapy for some forms of DCIS is overtreatment (median 4) and that active surveillance as an alternative management strategy should be studied (mean 4), but felt that ultrasound (median 4) and MRI (median 4) should be used to exclude women with occult invasive disease before active surveillance.Conclusions
Breast radiologists' opinions about DCIS biology, language, and active surveillance are not homogenous, but general trends exist that can be used to guide research, education, and advocacy efforts.
SUBMITTER: Grimm LJ
PROVIDER: S-EPMC8114676 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Ductal carcinoma in situ (DCIS) is a noninvasive breast lesion with uncertain risk for invasive progression. Usual care (UC) for DCIS consists of treatment upon diagnosis, thus potentially overtreating patients with low propensity for progression. One strategy to reduce overtreatment is active surveillance (AS), whereby DCIS is treated only upon detection of invasive disease. Our goal was to perform a quantitative evaluation of outcomes following an AS strategy for DCIS. Age-stratified, 10-year disease-specific cumulative mortality (DSCM) for AS was calculated using a computational risk projection model based upon published estimates for natural history parameters, and Surveillance, Epidemiology, and End Results data for outcomes. AS projections were compared with the DSCM for patients who received UC. To quantify the propagation of parameter uncertainty, a 95% projection range (PR) was computed, and sensitivity analyses were performed. Under the assumption that AS cannot outperform UC, the projected median differences in 10-year DSCM between AS and UC when diagnosed at ages 40, 55, and 70 years were 2.6% (PR = 1.4%-5.1%), 1.5% (PR = 0.5%-3.5%), and 0.6% (PR = 0.0%-2.4), respectively. Corresponding median numbers of patients needed to treat to avert one breast cancer death were 38.3 (PR = 19.7-69.9), 67.3 (PR = 28.7-211.4), and 157.2 (PR = 41.1-3872.8), respectively. Sensitivity analyses showed that the parameter with greatest impact on DSCM was the probability of understaging invasive cancer at diagnosis. AS could be a viable management strategy for carefully selected DCIS patients, particularly among older age groups and those with substantial competing mortality risks. The effectiveness of AS could be markedly improved by reducing the rate of understaging.
| S-EPMC4849804 | biostudies-literature
Project description:ObjectiveWe hypothesize that radiologists' estimated percentage likelihood assessments for the presence of ductal carcinoma in situ (DCIS) and invasive cancer may predict histologic outcomes.Materials and methodsTwo hundred fifty cases categorized as BI-RADS category 4 or 5 at four University of California Medical Centers were retrospectively reviewed by 10 academic radiologists with a range of 1-39 years in practice. Readers assigned BI-RADS category (1, 2, 3, 4a, 4b, 4c, or 5), estimated percentage likelihood of DCIS or invasive cancer (0-100%), and confidence rating (1 = low, 5 = high) after reviewing screening and diagnostic mammograms and ultrasound images. ROC curves were generated.ResultsSixty-two percent (156/250) of lesions were benign and 38% (94/250) were malignant. There were 26 (10%) DCIS, 20 (8%) invasive cancers, and 48 (19%) cases of DCIS and invasive cancer. AUC values were 0.830-0.907 for invasive cancer and 0.731-0.837 for DCIS alone. Sensitivity of 82% (56/68), specificity of 84% (153/182), positive predictive value (PPV) of 66% (56/85), negative predictive value (NPV) of 93% (153/165), and accuracy of 84% ([56 + 153]/250) were calculated using an estimated percentage likelihood of 20% or higher as the prediction threshold for invasive cancer for the radiologist with the highest AUC (0.907; 95% CI, 0.864-0.951). Every 20% increase in the estimated percentage likelihood of invasive cancer increased the odds of invasive cancer by approximately two times (odds ratio, 2.4). For DCIS, using a threshold of 40% or higher, sensitivity of 81% (21/26), specificity of 79% (178/224), PPV of 31% (21/67), NPV of 97% (178/183), and accuracy of 80% ([21 + 178]/250) were calculated. Similarly, these values were calculated at thresholds of 2% or higher (BI-RADS category 4) and 95% or higher (BI-RADS category 5) to predict the presence of malignancy.ConclusionUsing likelihood estimates, radiologists may predict the presence of invasive cancer with fairly high accuracy. Radiologist-assigned estimated percentage likelihood can predict the presence of DCIS, albeit with lower accuracy than that for invasive cancer.
| S-EPMC7777562 | biostudies-literature
Project description:Importance:Recent recognition of the overdiagnosis and overtreatment of ductal carcinoma in situ (DCIS) detected by mammography has led to the development of clinical trials randomizing women with non-high-grade DCIS to active surveillance, defined as imaging surveillance with or without endocrine therapy, vs standard surgical care. Objective:To determine the factors associated with underestimation of invasive cancer in patients with a clinical diagnosis of non-high-grade DCIS that would preclude active surveillance. Design, Setting, and Participants:A retrospective cohort study was conducted using records from the National Cancer Database from January 1, 1998, to December 31, 2012, of female patients 40 to 99 years of age with a clinical diagnosis of non-high-grade DCIS who underwent definitive surgical treatment. Data analysis was conducted from November 1, 2015, to February 4, 2017. Exposures:Patients with an upgraded diagnosis of invasive carcinoma vs those with a diagnosis of DCIS based on final surgical pathologic findings. Main Outcomes and Measures:The proportions of cases with an upgraded diagnosis of invasive carcinoma from final surgical pathologic findings were compared by tumor, host, and system characteristics. Results:Of 37?544 women (mean [SD] age, 59.3 [12.4] years) presenting with a clinical diagnosis of non-high-grade DCIS, 8320 (22.2%) had invasive carcinoma based on final pathologic findings. Invasive carcinomas were more likely to be smaller (>0.5 to ?1.0 cm vs ?0.5 cm: odds ratio [OR], 0.73; 95% CI, 0.67-0.79; >1.0 to ?2.0 cm vs ?0.5 cm: OR, 0.42; 95% CI, 0.39-0.46; >2.0 to ?5.0 cm vs ?0.5 cm: OR, 0.19; 95% CI, 0.17-0.22; and >5.0 cm vs ?0.5 cm: OR, 0.11; 95% CI, 0.08-0.15) and lower grade (intermediate vs low: OR, 0.75; 95% CI, 0.69-0.80). Multivariate logistic regression analysis demonstrated that younger age (60-79 vs 40-49 years: OR, 0.84; 95% CI, 0.77-0.92; and ?80 vs 40 to 49 years: OR, 0.76; 95% CI, 0.64-0.91), negative estrogen receptor status (positive vs negative: OR, 0.39; 95% CI, 0.34-0.43), treatment at an academic facility (academic vs community: OR, 2.08; 95% CI, 1.82-2.38), and higher annual income (>$63?000 vs <$38?000: OR, 1.14; 95% CI, 1.02-1.28) were significantly associated with an upgraded diagnosis of invasive carcinoma based on final pathologic findings. Conclusions and Relevance:When selecting patients for active surveillance of DCIS, factors other than tumor biology associated with invasive carcinoma based on final pathologic findings may need to be considered. At the time of randomization to active surveillance, a significant proportion of patients with non-high-grade DCIS will harbor invasive carcinoma.
| S-EPMC5710412 | biostudies-other
Project description:Ductal carcinoma in situ (DCIS) is a highly heterogeneous disease. It presents in a variety of ways and may or may not progress to invasive cancer, which poses challenges for both diagnosis and treatment. On May 15, 2017, the Dana-Farber/Harvard Cancer Center hosted a retreat for over 80 breast specialists including medical oncologists, surgical oncologists, radiation oncologists, radiologists, pathologists, physician assistants, nurses, nurse practitioners, researchers, and patient advocates to discuss the state of the science, treatment challenges, and key questions relating to DCIS. Speakers and attendees were encouraged to explore opportunities for future collaboration and research to improve our understanding and clinical management of this disease. Participants were from Dana-Farber Cancer Institute, Brigham and Women's Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Duke University Medical Center, and MD Anderson Cancer Center. The discussion focused on three main themes: epidemiology, detection, and pathology; state of the science including the biology of DCIS and potential novel treatment approaches; and risk perceptions, communication, and decision-making. Here we summarize the proceedings from this event.
| S-EPMC6307658 | biostudies-literature
Project description:OBJECTIVE: To review knowledge of computed tomography (CT) parameters and their influence on patient dose and image quality amongst a cohort of clinical specialist radiographers (CSRs) and examining radiologists. METHODS: A questionnaire survey was devised and distributed to a cohort of 65 examining radiologists attending the American Board of Radiology exam in Kentucky in November 2011. The questionnaire was later distributed by post to a matching cohort of Irish CT CSRs. Each questionnaire contained 40 questions concerning CT parameters and their influence on both patient dose and image quality. RESULTS: A response rate of 22 % (radiologists) and 32 % (CSRs) was achieved. No difference in mean scores was detected between either group (27.8 ± 4 vs 28.1 ± 4, P = 0.87) although large ranges were noted (18-36). Considerable variations in understanding of CT parameters was identified, especially regarding operation of automatic exposure control and the influence of kilovoltage and tube current on patient dose and image quality. Radiologists were unaware of recommended diagnostic reference levels. Both cohorts were concerned regarding CT doses in their departments. CONCLUSIONS: CT parameters were well understood by both groups. However, a number of deficiencies were noted which may have a considerable impact on patient doses and limit the potential for optimisation in clinical practice. KEY POINTS: • CT users must adapt parameters to optimise patient dose and image quality. • The influence of some parameters is not well understood. • A need for ongoing education in dose optimisation is identified.
| S-EPMC3781242 | biostudies-other
Project description:Ductal carcinoma in situ (DCIS) is a biologically heterogenous entity with uncertain risk for invasive ductal carcinoma (IDC) development. Standard treatment is surgical resection often followed by radiation. New approaches are needed to reduce overtreatment. This was an observational study that enrolled patients with DCIS who chose not to pursue surgical resection from 2002 to 2019 at a single academic medical center. All patients underwent breast MRI exams at 3- to 6-month intervals. Patients with hormone receptor-positive disease received endocrine therapy. Surgical resection was strongly recommended if clinical or radiographic evidence of disease progression developed. A recursive partitioning (R-PART) algorithm incorporating breast MRI features and endocrine responsiveness was used retrospectively to stratify risk of IDC. A total of 71 patients were enrolled, 2 with bilateral DCIS (73 lesions). A total of 34 (46.6%) were premenopausal, 68 (93.2%) were hormone-receptor positive, and 60 (82.1%) were intermediate- or high-grade lesions. Mean follow-up time was 8.5 years. Over half (52.1%) remained on active surveillance without evidence of IDC with mean duration of 7.4 years. Twenty patients developed IDC, of which 6 were HER2 positive. DCIS and subsequent IDC had highly concordant tumor biology. Risk of IDC was characterized by MRI features after 6 months of endocrine therapy exposure; low-, intermediate-, and high-risk groups were identified with respective IDC rates of 8.7%, 20.0%, and 68.2%. Thus, active surveillance consisting of neoadjuvant endocrine therapy and serial breast MRI may be an effective tool to risk-stratify patients with DCIS and optimally select medical or surgical management.SignificanceA retrospective analysis of 71 patients with DCIS who did not undergo upfront surgery demonstrated that breast MRI features after short-term exposure to endocrine therapy identify those at high (68.2%), intermediate (20.0%), and low risk (8.7%) of IDC. With 7.4 years mean follow-up, 52.1% of patients remain on active surveillance. A period of active surveillance offers the opportunity to risk-stratify DCIS lesions and guide decisions for operative management.
| S-EPMC10035518 | biostudies-literature
Project description:Computed tomography (CT) is a key imaging technique in diagnostic radiology, providing highly sensitive and specific information. While its use has increased dramatically in recent years, the quantity and associated risks of radiation from CT scans present major challenges, particularly in paediatrics. The fundamental principles of radiation protection require that radiation quantities be as low as reasonably achievable and CT use must be justified, particularly for paediatric patients. CT radiation knowledge is a key factor in optimising and minimising radiation risk. The objective of this study was to analyse knowledge level, expertise, and competency regarding CT radiation dose and its hazards in paediatrics among radiologists in Saudi Arabian hospitals. A self-reported, multiple-choice questionnaire assessed the attitudes and opinions of radiologists involved in imaging studies using ionising radiation. Among the total respondents, 65% ± 13.5% had a good comprehension of the dangers of carcinogenicity to the patient resulting from CT scans, with 80% presuming that cancer risks were elevated. However, only 48.5%, 56.5%, and 65% of the respondents were aware of specific radiation risks in head, chest, and abdominal paediatric examinations, respectively. Regular, frequent, and specific training courses are suggested to improve the fundamental knowledge of CT radiation among radiologists and other physicians.
| S-EPMC7563332 | biostudies-literature
Project description:ObjectiveTo assess the knowledge, opinions and expectations of persons with and without obesity concerning personalised genotype-based nutrition.DesignQuestions about nutrition, weight management and personalised genotype-based dietary recommendations were asked via standardised telephone-based interviews. Sociodemographic and anthropometric data were collected. The data were statistically weighted by age, gender, education, domicile and BMI.SettingGermany.ParticipantsRepresentative sample of the German population (n 1003) randomly sampled via a scientific Random Digit dial method plus 354 adults with a BMI ≥ 30·0 kg/m2 to enlarge the sample.ResultsData of 1357 participants were analysed (51·1 % female, age: 50·5 ± 18·5 years, 15·9 % adults with a BMI ≥ 30·0 kg/m2). About 42 % or 19 % of the survey participants stated to know the terms personalised dietary recommendation or genotype-based dietary recommendation, respectively. Of those, 15·8 % indicated to have an experience with a personalised or genotype-based dietary recommendation. Almost 70 % of the survey participants believed that a genotype-based dietary recommendation is a reasonable measure for weight management. About 55 % of the survey participants pointed out that a genotype-based dietary recommendation is an effective concept in general. One-third of the survey participants (34·6 %) indicated to conceive the usage of a genotype-based dietary recommendation.ConclusionMost of the survey participants did not know the term personalised or genotype-based dietary recommendation. One-third of the study participants are interested to use a genotype-based dietary recommendation. Therefore, more education of the public is necessary to properly help people making informed and serious decisions and assessing commercially available direct-to-consumer genetic tests.
| S-EPMC8094433 | biostudies-literature
Project description:Exotic pet medicine is rapidly evolving, with reptiles becoming increasingly popular pet animals. Yet, there are only a few literature reports on veterinary perception of reptiles kept as pets. The aim of the study was to assess opinions and knowledge of the Croatian veterinarians-to-be about pet reptiles and their welfare. The questionnaire survey was conducted in the academic year 2019-2020 and included students of all six years of the integrated undergraduate and graduate study at the Faculty of Veterinary Medicine, University of Zagreb. First-year students were surveyed twice, before and after having attended the compulsory course on animal welfare. Questionnaire statements were 5-point Likert scale questions, requiring the students to express their opinions about turtles, lizards and snakes as pets, issues related to their welfare, risks they pose to the health and safety of humans, other animals and the environment, and their self-reported knowledge about pet reptiles. Although expressing higher opinions after having attended the course on animal welfare, first-year student responses remained neutral to most of the statements. Such a trend continued until the end of the study. Student responses revealed that they were uncertain about their knowledge of reptiles as pets, considering different educational areas observed. Study results emphasised the need of alterations in veterinary curriculum and additional student education in reptile medicine. The results obtained have broad implications involving not only the welfare of pet reptiles in clinical practice and elsewhere but also the health and safety of humans and other animals, as well as environmental protection.
| S-EPMC8614325 | biostudies-literature
Project description:ObjectivesRadiologists' perception is likely to influence the adoption of artificial intelligence (AI) into clinical practice. We investigated knowledge and attitude towards AI by radiologists and residents in Europe and beyond.MethodsBetween April and July 2019, a survey on fear of replacement, knowledge, and attitude towards AI was accessible to radiologists and residents. The survey was distributed through several radiological societies, author networks, and social media. Independent predictors of fear of replacement and a positive attitude towards AI were assessed using multivariable logistic regression.ResultsThe survey was completed by 1,041 respondents from 54 mostly European countries. Most respondents were male (n = 670, 65%), median age was 38 (24-74) years, n = 142 (35%) residents, and n = 471 (45%) worked in an academic center. Basic AI-specific knowledge was associated with fear (adjusted OR 1.56, 95% CI 1.10-2.21, p = 0.01), while intermediate AI-specific knowledge (adjusted OR 0.40, 95% CI 0.20-0.80, p = 0.01) or advanced AI-specific knowledge (adjusted OR 0.43, 95% CI 0.21-0.90, p = 0.03) was inversely associated with fear. A positive attitude towards AI was observed in 48% (n = 501) and was associated with only having heard of AI, intermediate (adjusted OR 11.65, 95% CI 4.25-31.92, p < 0.001), or advanced AI-specific knowledge (adjusted OR 17.65, 95% CI 6.16-50.54, p < 0.001).ConclusionsLimited AI-specific knowledge levels among radiology residents and radiologists are associated with fear, while intermediate to advanced AI-specific knowledge levels are associated with a positive attitude towards AI. Additional training may therefore improve clinical adoption.Key points• Forty-eight percent of radiologists and residents have an open and proactive attitude towards artificial intelligence (AI), while 38% fear of replacement by AI. • Intermediate and advanced AI-specific knowledge levels may enhance adoption of AI in clinical practice, while rudimentary knowledge levels appear to be inhibitive. • AI should be incorporated in radiology training curricula to help facilitate its clinical adoption.
| S-EPMC8379099 | biostudies-literature