Abstract P6-16-03: The impact of ductal carcinoma in situ of the breast on health services utilization and general health and well-being of women
Authors: Rakovitch E , Sutradhar R , Zhou L , Nofech-Mozes S , Hanna W , Paszat L 
Published: May 2019

Abstract
Background: The impact of DCIS diagnosis on the development of significant anxiety and depression and on the utilization of breast imaging and breast biopsy procedures, which may reflect fears of breast cancer recurrence, is unknown. We established a population cohort of women with DCIS and examined the impact of the DCIS diagnosis on health services utilization (physician, emergency room visits) before and after DCIS, including those related to anxiety or depression, and all breast-related interventions, compared to similar women without DCIS.
Methods: From hospital claims we identified a population-based cohort of women with a first diagnosis of DCIS between 2010-2015. Cases with prior history of cancer were excluded. We identified treatment (mastectomy, breast-conserving surgery (BCS) +/- radiation therapy (RT) by linkage of administrative databases. Using DCIS diagnosis date for each case, we matched 5 unaffected controls (with no history of DCIS) by age, mammography history, socioeconomic status, and comorbidity at same date. For all cases and controls we extracted the following from physician billing claims: breast imaging (mammography, ultrasound, MRI), breast biopsies, breast surgery, all physician visits, and all hospital claims (including those with a diagnosis of anxiety or depression), for five years prior to and following the index date. We excluded claims from the year prior to and subsequent to the index date to remove the effect of services utilization surrounding the diagnosis and management of the index DCIS lesion. We then computed the rate of each service per 100 person-years for 5 years before and after the index date. Cases who developed local recurrence (LR) (and their matched controls) were censored 3 months prior to LR date. We used negative binomial regression to test differences in rates of service utilization before and after DCIS diagnosis and between cases and unaffected controls.
Results: The cohort includes 4,977 women treated for DCIS were identified, each matched to 5 controls. 911/4,977 (18.3%) of cases were &lt; 50 years old at diagnosis; 1,006/4,977 (20.2%) were treated by BCS alone, 2,995/4,977 (60.2%) by BCS+RT, and 976 (19.6%) by mastectomy. For cases diagnosed with visits with a breast diagnosis code, utilization of breast imaging procedures and the use of breast surgery was significantly greater relative to unaffected controls irrespective of age at diagnosis and treatment (all p values &lt;0.0001). Primary care visits were higher among cases (RR=1.10 (95% CI 1.06, 1.14), p&lt;0.0001), including those with a breast diagnosis code (RR=3.69 (95%CI 3.29, 4.14)). However, there was no increase in relative rates of physician or hospital visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32 p=0.11), psychiatry visits (RR 1.07 (95% CI 0.82, 1.40) p=0.6), non-breast surgical procedures (RR 1.10 (95% CI 0.88, 1.37) p=0.4), or emergency department visits (unrelated to breast) in cases with DCIS compared to unaffected controls.
Conclusion: DCIS is associated with more visits and procedures related to the breast compared to women without a diagnosis of DCIS but overall health services utilization and visits related to anxiety and depression were not increased.
Citation Format: Rakovitch E, Sutradhar R, Zhou L, Nofech-Mozes S, Hanna W, Paszat L. The impact of ductal carcinoma in situ of the breast on health services utilization and general health and well-being of women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-03.