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The impact of ductal carcinoma in situ on health services utilization

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To determine the intermediate-term impact of diagnosis and treatment of ductal carcinoma in situ of the breast (DCIS) on health services utilization, we compared utilization by cases of DCIS to unaffected controls.

Methods

We identified a population-based cohort of Ontario females diagnosed with DCIS between 2010 and 2015. We matched 5 controls without any history of cancer to each case, on the date of diagnosis of the case (the index date), by age, annual mammography history, socioeconomic status, and comorbidity. We identified billing claims and hospital records, during the interval 13 to 60 months prior to, and subsequent to the index date, and computed rates per 100 person-years during both intervals, to conduct a difference-in-differences analysis. We used negative binomial regression to test if the change in rates in health services differed between cases and controls.

Results

Visits with a breast diagnosis code, and claims for breast surgery and imaging, were significantly increased among cases compared to controls (all p values < 0.0001) after DCIS;however, there was no increase in visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32, p = 0.11), visits to psychiatrists (RR 1.07 (95% CI 0.82, 1.40) p = 0.6), or hospital procedures other than breast surgery (RR 1.10 (95% CI 0.88, 1.37) p = 0.4).

Conclusions

DCIS is associated with more visits and procedures related to the breast compared to controls following diagnosis and treatment, but other health services utilization and visits related to anxiety and depression were not increased.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Datasets were linked using unique encoded identifiers and analyzed at ICES from the Ministry of Health and Long-Term Care of Ontario (RPDB and OHIP), and Cancer Care Ontario (OCR). The opinions, results, views, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of the ICES, the Ministry of Health and Long-Term Care of Ontario, or Cancer Care Ontario, and no endorsement by these bodies is intended or should be inferred.

Funding

This work was funded by the Canadian Cancer Society Research Institute / Canadian Breast Cancer Foundation (Grant No 319337).

Author information

Authors and Affiliations

  1. University of Toronto, Sunnybrook Research Institute, T2-156-2075 Bayview Avenue, Toronto, ON, M4N 3M45, Canada

    Lawrence Paszat

  2. Dalla Lana School of Public Health, University of Toronto, G106 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Rinku Sutradhar

  3. University of Toronto, Sunnybrook Research Institute, T2-152 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Eileen Rakovitch

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  1. Lawrence Paszat
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Correspondence to Lawrence Paszat.

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Conflicts of interest

E Rakovitch has received research grant funding from Genomic Health Inc. All other authors declare no conflict of interest.

Ethical approval

This study was approved by the Sunnybrook Health Sciences Centre Research Ethics Board. It is an observational analysis, and no procedures or interventions were performed.

Informed consent

This is a population-based retrospective analysis. All personal identifiers for each case in this population cohort were removed. This study was facilitated through ICES which is named as a prescribed entity in Sect. 45 of PHIPA (Regulation 329/04, Sect. 18) which allows access and utilization of administrative data for research purposes with a waived requirement for consent.

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Paszat, L., Sutradhar, R. & Rakovitch, E. The impact of ductal carcinoma in situ on health services utilization. Breast Cancer Res Treat 182, 159–168 (2020). https://doi.org/10.1007/s10549-020-05664-9

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  • DOI: https://doi.org/10.1007/s10549-020-05664-9

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