DCIS management since publication of clinical practice recommendations: surgeons' practices and women's experiences

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Ductal Carcinoma in Situ of the breast (DCIS) now represents 15% of all new cases of breast cancer. Although a benign disease, its diagnosis increases a woman's risk of developing invasive breast cancer and the goal of treatment is prevention of invasive disease. However the characteristics that predict this progression have not been clearly identified. Consequently women are confused about their diagnosis and both clinicians and women are faced with complex treatment decisions. The National Breast Cancer Centre (NBCC) published a set of eight clinical practice recommendations for the management of DCIS in September 2003 and a guide for consumers in 2004. Currently there is no information regarding how the treatment recommendations have been received by surgeons, the extent management of DCIS now follows these recommendations or the impact of the treatment recommendations on the medical experiences of women with DCIS. This project will fill this gap. The project aims to: 1. Examine the impact of clinical practice recommendations for the management of Ductal Carcinoma in Situ (DCIS) of the breast on clinical practice 2. Determine awareness of and attitudes towards the recommendations among surgeons treating DCIS and to examine the relationship between these attitudes and clinical practice 3. Examine women's experience of a DCIS diagnosis, their understanding of its prognosis and involvement in treatment decisions after release of a consumer guide in 2004 This research will determine whether the publication of the treatment recommendations in 2003 influenced the medical care women with DCIS recieve and identify the factors associated with surgeons and women that facilitate or prevent the uptake of these recommendations. This information will be used to develop strategies increase surgeons' adoption of the treatment recommendations in order to ensure that all women with DCIS have access to the best care possible.