The incidence of ductal carcinoma in situ is on the rise in the United States, largely as a result of mammographic screening programs. The optimal treatment of this condition remains controversial for several reasons. DCIS is a heterogeneous condition the natural history of which remains unclear. In addition, although the mainstay of treatment has been mastectomy, it has not been directly compared with breast conserving surgery in a randomized controlled trial. Although radiotherapy has been demonstrated to reduce ipsilateral recurrence after breast conserving surgery, there is considerable controversy about which patients can safely forgo radiotherapy and the degree to which tamoxifen provides added value. Geographic variation in the treatments received by women with DCIS reflects the uncertainty about the best option for these patients and raises questions about the quality of clinical decision-making for these patients. Eleven states have enacted legislation to increase the amount of information patients have about their breast cancer treatment options. There is accumulating evidence from the study of the treatment options for early-stage invasive breast cancer that patients vary in how they view the risks and benefits of their options. This evidence argues for an expanded patient role in making treatment decisions. The goal of the proposed research is to develop the content of an interactive videodisc tool to disseminate information about treatment options to women with DCIS. This proposal builds on the investigators' extensive experience with the development of interactive videodisc tools and particularly with the development of such a program for women with invasive breast cancer. A core group of scientific consultants who are leaders in the field of breast cancer treatment have been identified to assist in the development of the program. The project will rely heavily on the experience of patients who have already been treated for DCIS to better understand the treatment decision from the patient's perspective and to identify spokeswomen to provide interviews for the videodisc program. In addition, we will highlight areas of clinical uncertainty to heighten the viewers' awareness of the need to participate in clinical trials. The proposal addresses three priority areas of the National Action Plan on Breast Cancer: information dissemination, consumer involvement, and clinical trials accessibility.
