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. 2025 Jul 27.
doi: 10.1245/s10434-025-17915-4. Online ahead of print.

Patient-reported Outcomes After Routine Treatment of In Situ/Atypical Lesions: The PORTAL Study

Shoshana M Rosenberg  1   2 , Christel Rushing  3 , Kristin L Schreiber  4 , Kerri-Anne Crowell  3 , Isabelle Bedrosian  5 , Kevin S Hughes  6   7 , Thomas Lynch  3 , Desiree Basila  8 , Deborah Collyar  8   9 , Elizabeth S Frank  10   8 , Sonja Darai  10 , Conor Lanahan  6 , Jeffrey R Marks  3 , Jennifer K Plichta  3 , Terry Hyslop  3   11 , Alastair M Thompson  12 , Ann H Partridge #  10 , E Shelley Hwang #  3
Affiliations

Patient-reported Outcomes After Routine Treatment of In Situ/Atypical Lesions: The PORTAL Study

Shoshana M Rosenberg et al. Ann Surg Oncol. .

Abstract

Background: Guideline concordant care (GCC) for ductal carcinoma in situ (DCIS) includes some combination of surgery, radiation, and/or endocrine treatment. Active monitoring (AM) is a common approach for high-risk breast histologies (e.g., atypical ductal hyperplasia [ADH] lobular intraepithelial neoplasias [LIN]) and has been proposed as an alternative to GCC for some low-risk DCIS. We compared patient-reported outcomes in women with DCIS who received GCC with those with other high-risk breast histologies in an active monitoring-proxy group (AM-P).

Methods: Women diagnosed with DCIS (GCC) or ADH/LIN (AM-P) from 2012 to 2017 at four cancer centers were surveyed regarding surgical-area pain, severity, and burden, generalized pain, anxiety, depression, and quality of life (QOL). The primary comparison was GCC versus AM-P. Multivariable logistic regression was used to model odds of reporting surgical-area pain. Multivariable marginal zero-inflated negative binomial models estimated mean scores and differences by group.

Results: A total of 912 women completed the survey (GCC, n = 538; AM-P, n = 374). At a median of 45.4 months following diagnosis, the AM-P group had lower odds of pain in the past month (0.35, 95% CI 0.25-0.49) and clinically significant pain (0.43, 95% CI 0.28-0.68). Adjusted mean pain severity index, surgical area sensory disturbance, pain-related cognitive/emotional impact scores were lower in the AM-P versus GCC group. Generalized pain, QOL, anxiety, and depressive symptoms were similar between groups.

Conclusions: Women with DCIS treated with GCC experienced more breast/chest wall pain than women in the AM-P group, although QOL was similar. Understanding these trade-offs can inform surgical de-escalation for high-risk lesions, including low-risk DCIS.

Keywords: Active monitoring; Atypical ductal hyperplasia; Ductal carcinoma in situ; Lobular intraepithelial neoplasia; Pain; Patient-reported outcomes; Quality of life; Surgery.

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Conflict of interest statement

Disclosure: Dr. Shoshana Rosenberg has received grant support from Pfizer/Conquer Cancer. Dr. Kevin Hughes receives Honoraria from TME (Targeted Medical Education, genetics education and consulting), Invitae (Genetic testing), Natera (Genetic testing), Hologic (Biozorb, Breast surgery devices), Volpara (Cancer risk assessment), and Astra Zeneca (Pharmaceutical Company). He has a financial interest in CRA Health and is the Co-Creator of Ask2Me.Org. Deborah Collyar receives an honorarium from the Antibacterial Resistance Leadership Group (ARLG) and HMP Education. She also receives consulting fees from SimBioSys, MaxisHealth, Health Literacy Media (HLM), Apellis Pharmaceuticals, Inc., and Kinnate Biopharma. Dr. Plichta was the recipient of research funding by the Color Foundation and Earlier.org. She is supported in part through the NIH grant K12HD043446 (PI: Amundsen). Dr. Ann Partridge receives royalties from Wolters Kluwer and has received research support from Novartis. Dr. Shelley Hwang serves on the advisory boards for Novartis, Merck, Lumicell, and exai bio.

References

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