Physician's comfort level with observing ductal carcinoma in situ of the breast: a survey of breast specialists at accredited breast centers in the United States

Background: Ongoing clinical trials are investigating the role of observation for ductal carcinoma in situ (DCIS). The objective of this study was to assess breast specialist's opinions on observing DCIS and recruitment to trials that involve observation of DCIS. Methods: A cross-sectional survey assessing physician opinions on observation of DCIS and knowledge of DCIS recurrence rates was administered to physicians practicing at breast centers accredited by the National Accreditation Program for Breast Centers (NAPBC) from 2018-2019. Results: Three hundred and seventy-nine out of 603 NAPBC centers (63%) participated and 979 out of 1,761 (56%) physicians responded. Three hundred (32%) were medical oncologists, 316 (33.7%) were radiation oncologists and 322 (34.3%) were surgeons. Only 301 (31.1%) physicians were categorized into the high knowledge group. In total, 659 physicians (70.7%) estimated that <20% of their patients could be initially observed and 746 (76.5%) felt it would be somewhat to very difficult to recruit patients to a DCIS observation trial. The top three most important reasons for not participating in a DCIS observation trial were: concerns for high risk of disease progression (n=540, 57.0%), worry about tumor upstaging seen with surgery (n=422, 44.3%) and patient unwillingness to consent (n=401, 42.6%). On multivariable analysis, there were no physician or knowledge factors associated with comfort level of observing low-grade or estrogen receptor positive DCIS. Conclusions: Many physicians are hesitant to observe patients with DCIS. Knowledge levels about recurrence rates with DCIS are low but knowledge level was not associated with physician comfort level in putting patients on DCIS observation trials.