Surgical Treament for Early State Breast Cancer

描述(申请人提供)：导管原位癌的发病率 在美国女性中，乳房死亡率(DCIS)大幅上升 自20世纪80年代初以来，S。无论是哪种类型的原位癌，存活率都很高 手术治疗的风险，对于组织病理学良好的患者，风险 肿瘤切除术后局部复发率很低。然而，有很大的 DCIS患者手术治疗的多样性。尽管许多女性 DCIS似乎是保乳治疗的理想候选者， 这种特殊形式的乳腺癌的乳房切除率仍然很高。这 引发了临床医生和患者对“过度治疗”的担忧 倡导团体都是如此。不幸的是，我们对这些因素知之甚少。 影响乳腺癌手术选择和复杂的手术过程 作出治疗决定是为了充分了解这些辩论。此外，我们 几乎没有关于结果的信息，如患者满意度或 DCIS患者随后的生活质量，以及在多大程度上 DCIS患者和侵袭性患者的重要结局可能不同 乳腺癌。 我们提出了一项基于多中心人口的研究，以检查一系列广泛的 决定因素(外部影响、临床因素、诱因/使能 因素、患者知识和态度因素)相关联 最近诊断为乳腺癌的女性有三种结果：1) 手术治疗选择(乳房切除与肿块切除加或不加放疗)； 2)患者对治疗决定的短期满意度和 治疗过程；3)与健康相关的生活质量。这项研究将 使用以人群为基础的乳腺癌患者样本进行调查 美国种族和社会经济多元化的城市地区 (底特律、洛杉矶和亚特兰大)。最近对2900名妇女进行的初步抽样 确诊病例将从三个监测、流行病学中进行前瞻性选择 和最终结果(SEER)在15个月内使用快速 案件查明过程。这个样本将按疾病级别进行分层。 (1450名女性DCIS患者和1450名侵袭性疾病患者)，我们将进行过度抽样 非裔美国女性。符合条件的女性同意参加这项研究将 收到标准化的调查问卷，邮寄给 自治。根据我们在底特律SEER站点的试点经验，我们 预计约75%的符合研究条件的患者将 填写完整问卷(N=1880份)。

DESCRIPTION (provided by applicant): The incidence of ductal carcinoma in situ of the breast (DCIS) has risen dramatically among women in the United States since the early 1980's. Survival for DCIS is very high regardless of the type of surgical treatment and, for patients with favorable histopathology, the risk of local recurrence post-lumpectomy is very low. There are, however, large variations in the surgical management of DCIS patients. Although many women with DCIS appear to be ideal candidates for breast conserving therapy, mastectomy rates for this particular form of breast cancer remain high. This has led to concerns about "over treatment" among clinicians and patient advocacy groups alike. Unfortunately, we do not know enough about the factors that influence breast cancer surgery choice and the processes by which complex treatment decisions are made to fully inform these debates. Furthermore, we have little information about outcomes such as patient satisfaction or subsequent quality of life for women with DCIS, and to what extent these important outcomes may differ between women with DCIS and those with invasive breast cancer. We propose a multi-center population-based study to examine a broad array of determinants (external influences, clinical factors, predisposing/enabling factors, and patient knowledge and attitudinal factors) that are associated with three outcomes for women recently diagnosed with breast cancer: 1) surgical treatment choice (mastectomy vs lumpectomy with or without radiation); 2) short-term patient satisfaction with the treatment decision and the treatment-making process; and 3) health-related quality of life. The study will be conducted using a population-based sample of breast cancer patients in three racially and socioeconomically diverse urban areas in the United States (Detroit, Los Angeles and Atlanta). An initial sample of 2900 women recently diagnosed will be selected prospectively from three Surveillance, Epidemiology and End Results (SEER) catchment areas over a 15-month period using a rapid case ascertainment process. This sample will be stratified by level of disease (1450 women with DCIS and 1450 with invasive disease), and we will oversample African-American women. Eligible women consenting to be in the study will receive a standardized survey questionnaire in the mail for self-administration. Based on our pilot experience in the Detroit SEER site, we expect that approximately 75 percent of patients eligible for the study will complete questionnaires (N=l880).