{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:49:21Z","timestamp":1793134161489,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T00:00:00Z","timestamp":1628208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C38317"],"award-info":[{"award-number":["C38317"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004622","name":"KWF Kankerbestrijding","doi-asserted-by":"publisher","award":["A24043"],"award-info":[{"award-number":["A24043"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>As ongoing trials study the safety of an active surveillance strategy for low-risk ductal carcinoma in situ (DCIS), there is a need to explain why particular choices regarding treatment strategies are made by eligible women as well as their oncologists, what factors enter the decision process, and how much each factor affects their choice. To measure preferences for treatment and surveillance strategies, women with newly-diagnosed, primary low-risk DCIS enrolled in the Dutch CONTROL DCIS Registration and LORD trial, and oncologists participating in the Dutch Health Professionals Study were invited to complete a discrete choice experiment (DCE). The relative importance of treatment strategy-related attributes (locoregional intervention, 10-year risk of ipsilateral invasive breast cancer (iIBC), and follow-up interval) were discerned using conditional logit models. A total of n = 172 patients and n = 30 oncologists completed the DCE. Patient respondents had very strong preferences for an active surveillance strategy with no surgery, irrespective of the 10-year risk of iIBC. Extensiveness of the locoregional treatment was consistently shown to be an important factor for patients and oncologists in deciding upon treatment strategies. Risk of iIBC was least important to patients and most important to oncologists. There was a stronger inclination toward a twice-yearly follow-up for both groups compared to annual follow-up.<\/jats:p>","DOI":"10.3390\/cancers13163962","type":"journal-article","created":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T05:22:01Z","timestamp":1628227321000},"page":"3962","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8754-0530","authenticated-orcid":false,"given":"Danalyn","family":"Byng","sequence":"first","affiliation":[{"name":"Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5624-3234","authenticated-orcid":false,"given":"Valesca","family":"Ret\u00e8l","sequence":"additional","affiliation":[{"name":"Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0016-4972","authenticated-orcid":false,"given":"Ellen","family":"Engelhardt","sequence":"additional","affiliation":[{"name":"Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"},{"name":"Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina","family":"Groothuis-Oudshoorn","sequence":"additional","affiliation":[{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5416-5893","authenticated-orcid":false,"given":"Janine","family":"van Til","sequence":"additional","affiliation":[{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8176-9684","authenticated-orcid":false,"given":"Ren\u00e9e","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederieke","family":"van Duijnhoven","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8940-2676","authenticated-orcid":false,"given":"Jelle","family":"Wesseling","sequence":"additional","affiliation":[{"name":"Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eveline","family":"Bleiker","sequence":"additional","affiliation":[{"name":"Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"van Harten","sequence":"additional","affiliation":[{"name":"Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands"},{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"on behalf of the Grand Challenge Precision Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/j.ejca.2015.05.008","article-title":"Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ\u2014The LORD study","volume":"51","author":"Elshof","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1016\/j.ejca.2015.07.017","article-title":"Addressing overtreatment of screen detected DCIS; the LORIS trial","volume":"51","author":"Francis","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_3","first-page":"325","article-title":"The LORIS trial: Randomising patients with lowor low intermediate-grade ductal carcinoma in situ (DCIS) to surgery or active monitoring","volume":"167","author":"Wallis","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e026797","DOI":"10.1136\/bmjopen-2018-026797","article-title":"The COMET (comparison of operative versus monitoring and endocrine therapy) trial: A phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS)","volume":"9","author":"Hwang","year":"2019","journal-title":"BMJ Open"},{"key":"ref_5","first-page":"62","article-title":"Surgery versus monitoring and endocrine therapy for low-risk DCIS: The COMET trial","volume":"102","author":"Youngwirth","year":"2017","journal-title":"Bull. Am. Coll. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s10549-019-05514-3","article-title":"UK Interdisciplinary Breast Cancer Symposium 2020","volume":"180","author":"Cuzick","year":"2020","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e031151","DOI":"10.1136\/bmjopen-2019-031151","article-title":"Partially randomised patient preference trials as an alternative design to randomised controlled trials: Systematic review and meta-analyses","volume":"9","author":"Wasmann","year":"2019","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4120","DOI":"10.1200\/JCO.20.01382","article-title":"Road map to safe and well-designed de-escalation trials of systemic adjuvant therapy for solid tumors","volume":"38","author":"Piccart","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1093\/jncimonographs\/lgq039","article-title":"Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast","volume":"2010","author":"Correa","year":"2010","journal-title":"J. Natl. Cancer Inst. Monogr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1200\/JCO.2014.57.9029","article-title":"Rtog 9804: A prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation","volume":"33","author":"McCormick","year":"2015","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/jnci\/djr027","article-title":"Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS","volume":"103","author":"Wapnir","year":"2011","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3613","DOI":"10.1200\/JCO.2014.56.2595","article-title":"Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized swedcis trial","volume":"32","author":"Garmo","year":"2014","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1200\/JCO.2010.34.0141","article-title":"Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: A study based on nsabp protocol b-24","volume":"30","author":"Allred","year":"2012","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/S0140-6736(15)01129-0","article-title":"Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (ibis-ii dcis): A double-blind, randomised controlled trial","volume":"387","author":"Forbes","year":"2016","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/S0140-6736(15)01168-X","article-title":"Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): A randomised, double-blind, phase 3 clinical trial","volume":"387","author":"Margolese","year":"2016","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.ijrobp.2018.08.048","article-title":"Randomized trial evaluating radiation following surgical excision for \u201cgood risk\u201d DCIS: 12-year report from NRG\/RTOG 9804","volume":"102","author":"McCormick","year":"2018","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.janxdis.2006.03.014","article-title":"Fearing the unknown: A short version of the intolerance of uncertainty scale","volume":"21","author":"Carleton","year":"2007","journal-title":"J. Anxiety Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jbtep.2012.07.004","article-title":"Confirmatory factor analysis of the Dutch intolerance of uncertainty scale: Comparison of the full and short version","volume":"44","author":"Helsen","year":"2013","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1002\/jclp.21965","article-title":"Intolerance of uncertainty: A common factor in the treatment of emotional disorders","volume":"69","author":"Boswell","year":"2013","journal-title":"J. Clin. Psychol."},{"key":"ref_20","first-page":"300","article-title":"Statistical methods for the analysis of discrete choice experiments: A report of the ISPOR conjoint analysis good research practices task force","volume":"19","author":"Hauber","year":"2016","journal-title":"Value Health J. Int. Soc. Pharm. Outcomes Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1016\/S0959-8049(20)30617-1","article-title":"Women diagnosed with ductal carcinoma in situ (DCIS) and healthcare providers\u2019 views on active surveillance for DCIS. Results from focus groups and in-depth interviews","volume":"138","author":"Engelhardt","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_22","unstructured":"Johnson, R., and Orme, B. (2003). Getting the Most from CBC, Sawtooth Software."},{"key":"ref_23","unstructured":"Orme, B. (1998). Sample Size Issues for Conjoint Analysis Studies, Sawtooth Software. Sawtooth Software Technical Paper."},{"key":"ref_24","unstructured":"Zarembka, P. (1973). Conditional Logit Analysis of Qualitative Choice Behavior. Frontiers in Econometrics, Academic Press."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jonczyk, M.M., Fisher, C.S., Babbitt, R., Paulus, J.K., Freund, K.M., Czerniecki, B., Margenthaler, J.A., Losken, A., and Chatterjee, A. (2021). Surgical predictive model for breast cancer patients assessing acute postoperative complications: The breast cancer surgery risk calculator. Ann. Surg. Oncol., 1\u201311.","DOI":"10.1245\/s10434-021-09710-8"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00238-013-0922-4","article-title":"Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery","volume":"37","author":"Rose","year":"2014","journal-title":"Eur. J. Plast. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kahneman, D., and Tversky, A. (2013). Prospect theory: An analysis of decision under risk. Handbook of the Fundamentals of Financial Decision Making: Part I, World Scientific.","DOI":"10.1142\/9789814417358_0006"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/hec.772","article-title":"Threats to the estimation of benefit: Are preference elicitation methods accurate?","volume":"12","author":"Lloyd","year":"2003","journal-title":"Health Econ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1016\/j.juro.2016.01.108","article-title":"The relationship between intolerance of uncertainty and anxiety in men on active surveillance for prostate cancer","volume":"195","author":"Tan","year":"2016","journal-title":"J. Urol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3534","DOI":"10.1245\/s10434-017-6018-9","article-title":"Surgical Upstaging Rates for Vacuum Assisted Biopsy Proven DCIS: Implications for Active Surveillance Trials","volume":"12","author":"Grimm","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Nicosia, L., di Giulio, G., Bozzini, A.C., Fanizza, M., Ballati, F., Rotili, A., Lazzeroni, M., Latronico, A., Abbate, F., and Renne, G. (2021). Complete Removal of the Lesion as a Guidance in the Management of Patients with Breast Ductal Carcinoma In Situ. Cancers, 13.","DOI":"10.3390\/cancers13040868"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s10549-019-05362-1","article-title":"Reliability of preoperative breast biopsies showing ductal carcinoma in situ and implications for non-operative treatment: A cohort study","volume":"178","author":"Mannu","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jval.2010.11.013","article-title":"Conjoint analysis applications in health\u2014A checklist: A report of the ISPOR good research practices for conjoint analysis task force","volume":"14","author":"Bridges","year":"2011","journal-title":"Value Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1093\/annonc\/mdz173","article-title":"Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up\u2020","volume":"30","author":"Cardoso","year":"2019","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med Oncol."},{"key":"ref_35","unstructured":"(2021, February 14). Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02492607."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chapman, B.M., Yang, J.C., Gonzalez, J.M., Havrilesky, L., Reed, S.D., and Hwang, E.S. (2021). Patient preferences for outcomes following DCIS management strategies: A discrete choice experiment. JCO Oncol. Pract., OP2000614.","DOI":"10.1200\/OP.20.00614"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s40271-017-0282-4","article-title":"Scale heterogeneity in healthcare discrete choice experiments: A primer","volume":"11","author":"Vass","year":"2018","journal-title":"Patient"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jarmac.2014.09.005","article-title":"How far does it feel? Construal level and decisions under risk","volume":"4","author":"Raue","year":"2015","journal-title":"J. Appl. Res. Mem. Cogn."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/16\/3962\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:41:24Z","timestamp":1760164884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/16\/3962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,6]]},"references-count":38,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["cancers13163962"],"URL":"https:\/\/doi.org\/10.3390\/cancers13163962","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,6]]}}}