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Overdiagnosis and Overtreatment of Breast Cancer: How Can We Promote Informed Patient Choice?

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Abstract

Stemming from closer examination of breast cancer incidence treads, there has been growing concern about the issues of overdiagnosis and overtreatment of breast cancer. As incidence trends showing a limited decline in later stage cancers shed doubt on the extent of benefit screening mammography holds, women need to be informed accordingly. However, it is apparent that women often do not fully understand the risks and benefits they face when undergoing screening mammography. Further, treatment decisions for women diagnosed with breast cancer are equally, if not more challenging, and studies suggest women are ill-informed here too. As the science improves and allows us to better differentiate bad acting cancers from those with no or limited risk, improved communication tools such as decision aids and shared decision making will be imperative as a means to promote informed patient choice.

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References

  1. Esserman LJ, Thompson IM, Reid B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA. 2013;310:797–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23896967. Accessed September 17, 2013.

    Article  PubMed  Google Scholar 

  2. Global Conference Statement “Preventing Overdiagnosis.” 2013. Available at: http://tdi.dartmouth.edu/press/press-releases/global-conference-statement-preventing-overdiagnosis. Accessed October 6, 2013.

  3. Ozanne EM, Shieh Y, Barnes J, Bouzan C, Hwang ES, Esserman LJ. Characterizing the impact of 25 years of DCIS treatment. Breast Cancer Res Treat. 2011;129:165–73. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21390494. Accessed February 4, 2013.

    Article  PubMed  Google Scholar 

  4. Rosselli Del Turco M, Paci E. Mammography and overdiagnosis. Ann Oncol. 1993;4:9–10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8435372. Accessed October 6, 2013.

    Article  PubMed  CAS  Google Scholar 

  5. American Cancer Society. American Cancer Society recommendations for early breast cancer detection. Available at: http://www.cancer.org/healthy/findcancerearly/womenshealth/non-cancerousbreastconditions/non-cancerous-breast-conditions-a-c-s-recs-for-early-detection. Accessed 6 Oct 2013.

  6. Practice Bulletin No. 122: breast cancer screening. Obstet Gynecol. 2011;118(2 Pt 1):372–82. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21775869. Accessed October 6, 2013.

  7. Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012;367:1998–2005. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23171096. Accessed September 19, 2013.

    Article  PubMed  CAS  Google Scholar 

  8. Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ. 2009;339:b2587. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2714679&tool=pmcentrez&rendertype=abstract. Accessed September 22, 2013.

    Article  PubMed  Google Scholar 

  9. Gavaruzzi T, Lotto L, Rumiati R, Fagerlin A. What makes a tumor diagnosis a call to action? On the preference for action vs inaction. Med Decis Making. 2013;31:237–44. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20671207. Accessed September 20, 2013.

    Article  Google Scholar 

  10. Welch HG, Black WC. Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med. 1997;127:1023–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9412284. Accessed October 6, 2013.

    Article  PubMed  CAS  Google Scholar 

  11. Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Risky feelings: why a 6% risk of cancer does not always feel like 6%. Patient Educ Couns. 2010;81(Suppl):S87–93. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2993812&tool=pmcentrez&rendertype=abstract. Accessed October 6, 2013.

    Article  PubMed  Google Scholar 

  12. Scherer LD, Ubel PA, McClure J, et al. Belief in numbers: when and why women disbelieve tailored breast cancer risk statistics. Patient Educ Couns. 2013;92:253–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23623330. Accessed October 7, 2013.

    Article  PubMed  Google Scholar 

  13. Esserman L, Sepucha K, Ozanne E, Hwang ES. Applying the neoadjuvant paradigm to ductal carcinoma in situ. Ann Surg Oncol. 2004;11(1 Suppl):28S–36S. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15015707. Accessed February 4, 2013.

    Article  PubMed  Google Scholar 

  14. Hwang ES, Esserman L. Neoadjuvant hormonal therapy for ductal carcinoma in situ: trial design and preliminary results. Ann Surg Oncol. 2004;11(1 Suppl):37S–43S. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15015708. Accessed October 7, 2013.

    Article  PubMed  Google Scholar 

  15. Omer ZB, Hwang ES, Esserman LJ, Howe R, Ozanne EM. Impact of ductal carcinoma in situ terminology on patient treatment preferences. JAMA Intern Med. 2013. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23978843. Accessed September 24, 2013.

  16. Ubel PA, Angott AM, Zikmund-Fisher BJ. Physicians recommend different treatments for patients than they would choose for themselves. Arch Intern Med. 2011;171:630–4. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=227069. Accessed October 7, 2013.

    Article  PubMed  Google Scholar 

  17. Stacey D, Bennett CL, Barry MJ, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;10:CD001431.

    Google Scholar 

  18. Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282:2313–20.

    Article  PubMed  Google Scholar 

  19. Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368:6–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23281971. Accessed September 26, 2013.

    Article  PubMed  Google Scholar 

  20. Katz SJ. The value of sharing treatment decision making with patients: expecting too much? JAMA. 2013. Available at: http://jama.jamanetwork.com/article.aspx?articleid=1741778. Accessed September 25, 2013.

  21. Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19224844. Accessed October 7, 2013.

    Article  PubMed  Google Scholar 

  22. Tuttle TM, Abbott A, Arrington A, Rueth N. The increasing use of prophylactic mastectomy in the prevention of breast cancer. Curr Oncol Rep. 2010;12:16–21. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20425603. Accessed October 7, 2013.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Elissa M. Ozanne declares that she has no conflict of interest.

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  1. The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH, 03766, USA

    Elissa M. Ozanne

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  1. Elissa M. Ozanne
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Correspondence to Elissa M. Ozanne.

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Ozanne, E.M. Overdiagnosis and Overtreatment of Breast Cancer: How Can We Promote Informed Patient Choice?. Curr Breast Cancer Rep 5, 263–265 (2013). https://doi.org/10.1007/s12609-013-0128-6

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