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- Title
Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis.
- Authors
Wong, Stephanie M.; Stout, Natasha K.; Punglia, Rinaa S.; Prakash, Ipshita; Sagara, Yasuaki; Golshan, Mehra
- Abstract
<bold>Background: </bold>Women diagnosed with lobular carcinoma in situ (LCIS) have a 3-fold to 10-fold increased risk of developing invasive breast cancer. The objective of this study was to evaluate the life expectancy (LE) and differences in survival offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy among women with LCIS.<bold>Methods: </bold>A Markov simulation model was constructed to determine average LE and quality-adjusted LE (QALE) gains for hypothetical cohorts of women diagnosed with LCIS at various ages under alternative risk-reduction strategies. Probabilities for invasive breast cancer, breast cancer-specific mortality, other-cause mortality and the effectiveness of preventive strategies were derived from published studies and from the National Cancer Institute's Surveillance, Epidemiology, and End Results database.<bold>Results: </bold>Assuming a breast cancer incidence from 1.02% to 1.37% per year under active surveillance, a woman aged 50 years diagnosed with LCIS would have a total LE of 32.78 years and would gain 0.13 years (1.6 months) in LE by adding chemoprevention and 0.25 years (3.0 months) in LE by adding bilateral prophylactic mastectomy. After quality adjustment, chemoprevention resulted in the greatest QALE for women ages 40 to 60 years at LCIS diagnosis, whereas surveillance remained the preferred strategy for optimizing QALE among women diagnosed at age 65 years and older.<bold>Conclusions: </bold>In this model, among women with a diagnosis of LCIS, breast cancer prevention strategies only modestly affected overall survival, whereas chemoprevention was modeled as the preferred management strategy for optimizing invasive disease-free survival while prolonging QALE form women younger than 65 years. Cancer 2017;123:2609-17. © 2017 American Cancer Society.
- Subjects
LOBULAR carcinoma in situ; BREAST cancer; CANCER prevention; CHEMOPREVENTION; MASTECTOMY; DISEASE incidence; NATIONAL Cancer Institute (U.S.); ANTINEOPLASTIC agents; BREAST tumor prevention; BREAST tumor treatment; BREAST tumors; DECISION making; DECISION trees; LIFE expectancy; EVALUATION of medical care; PROBABILITY theory; SURVIVAL; QUALITY-adjusted life years; LOBULAR carcinoma
- Publication
Cancer (0008543X), 2017, Vol 123, Issue 14, p2609
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.30644