BACKGROUND Mammographic screening reduces breast cancer mortality but may lead to the overdiagnosis and overtreatment of low-risk breast cancers. Conservative management may reduce the potential harm of overtreatment, yet little is known about the impact upon quality of life. OBJECTIVES To quantify women's preferences for managing low-risk screen detected ductal carcinoma in situ (DCIS), including the acceptability of active monitoring as an alternative treatment. METHODS Utilities (cardinal measures of quality of life) were elicited from 172 women using visual analogue scales (VASs), standard gambles, and the Euro-Qol-5D-5L questionnaire for seven health states describing treatments for low-risk DCIS. Sociodemographics and breast cancer history were examined as predictors of utility. RESULTS Both patients and non-patients valued active monitoring more favourably on average than conventional treatment. Utilities were lowest for DCIS treated with mastectomy (VAS: 0.454) or breast conserving surgery (BCS) with adjuvant radiotherapy (VAS: 0.575). The utility of active monitoring was comparable to BCS alone but was rated more favourably as progression risk was reduced from 40% to 10%. Disutility for active monitoring was likely driven by anxiety around progression, whereas conventional management impacted other dimensions of quality of life. The heterogeneity between individual preferences could not be explained by sociodemographic variables, suggesting that the factors influencing women's preferences are complex. CONCLUSIONS Active monitoring of low-risk DCIS is likely to be an acceptable alternative for reducing the impact of overdiagnosis and overtreatment in terms of quality of life. Further research is required to determine subgroups more likely to opt for conservative management.

中文翻译：

---

重视治疗筛查检测到的原位导管癌的偏好。


背景技术乳房X线照相筛查可降低乳腺癌死亡率，但可能导致低风险乳腺癌的过度诊断和过度治疗。保守治疗可能会减少过度治疗的潜在危害，但对其对生活质量的影响却知之甚少。目的 量化女性对管理低风险筛查检测的导管原位癌 (DCIS) 的偏好，包括对主动监测作为替代治疗的可接受性。方法 使用视觉模拟量表 (VAS)、标准赌博和 Euro-Qol-5D-5L 问卷从 172 名女性中得出效用（生活质量的主要衡量标准），针对 7 种健康状况描述低风险 DCIS 的治疗方法。社会人口统计学和乳腺癌病史被作为效用的预测因素进行了检查。结果 平均而言，患者和非患者都比传统治疗更看重主动监测。采用乳房切除术（VAS：0.454）或保乳手术（BCS）联合辅助放疗（VAS：0.575）治疗的 DCIS 的效用最低。主动监测的效用与单独的 BCS 相当，但由于进展风险从 40% 降低至 10%，因此评价更佳。主动监测的效用可能是由对进展的焦虑造成的，而传统的管理则影响生活质量的其他方面。个体偏好之间的异质性无法用社会人口变量来解释，这表明影响女性偏好的因素是复杂的。结论 积极监测低风险 DCIS 可能是减少过度诊断和过度治疗对生活质量影响的可接受的替代方案。 需要进一步的研究来确定更有可能选择保守管理的亚组。