Exploring women’s decision-making about surgery or active surveillance for the management of low-risk ductal carcinoma in-situ

Project Outline

Mammographic breast screening has resulted in a dramatic increase in the diagnosis of Ductal Carcinoma in situ (DCIS), a largely asymptomatic pre-cancerous condition. Standard treatment is complete surgical excision (possibly mastectomy), often followed by radiotherapy and/or endocrine therapy. However, data suggests that less than half of DCIS will progress to invasive breast cancer, with potentially only 10% of low-grade DCIS becoming invasive. Concerns regarding overtreatment, have resulted in several international clinical trials investigating the safety and acceptability of active surveillance as an alternative to surgery.

These ‘no treatment’ trials can be challenging to recruit to. The recent UK Low Risk DCIS Trial of surgery compared to active surveillance failed to recruit sufficient women for statistical analysis.
In the absence of data on the potential clinical outcomes of active surveillance for DCIS, this PhD will seek to address the choice of surgery or active surveillance from a different perspective: under what circumstances would women choose active surveillance compared to surgery?

This project will use qualitative research methods, systematic reviews, and a discrete choice experiment survey to explore which attributes of DCIS management would drive patient choice. The student will first conduct qualitative interviews to explore which factors influence women’s choice of DCIS management. They will then design a Discrete Choice Experiment survey in a sample of women previously treated for DCIS recruited from NHS breast clinics (n=~100) and members of the public (n=2000). They will analyse the data to provide evidence as to under which circumstances women would choose surgery or active surveillance and how this may differ in different groups. Finally, they will explore how the predictions of models estimated in this survey compare to the actual choices that women made in the ongoing Dutch LORD patient-choice trial.

Applications for this project are now open. Please complete your application on The University of Manchester website.