New findings from a longitudinal cohort study suggest that minoritised racial identity, non-private insurance, and undergoing more than one surgery are significantly associated with poorer mental and physical health outcomes two years after treatment for ductal carcinoma in situ (DCIS). The study highlights persistent health-related quality of life (HRQL) gaps among women treated for early-stage breast cancer and calls for targeted mental health interventions for those at greatest risk.
Published in JAMA Network Open, the study analysed 296 women enrolled in a national ECOG-ACRIN Cancer Research Group trial (E4112) between 2015 and 2016. Participants had recently been diagnosed with unilateral DCIS and were eligible for wide local excision (WLE). Patient-reported outcomes (PROs) were collected at registration, after surgical consultation, immediately after surgery, and again at 12 and 24 months postoperatively. Clinical history, social determinants of health, and the number of surgeries were also recorded.
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At baseline, most participants were White (77%), privately insured (77%), and living in areas of low to moderate deprivation (median ADI: 44). Overall, participants demonstrated good knowledge of DCIS (median score: 80/100) and a strong sense of being well-informed about their care (median score: 10/10).
However, at 24 months, mental HRQL was significantly lower among women from minoritised racial groups (American Indian or Alaska Native, Asian, Black, multiracial, or not reported), those with non-private insurance, and those who had undergone more than one surgery. Notably, women who were both non-White and had more than one surgery experienced a clinically meaningful and sustained decline in mental health, exceeding the threshold for a minimal important change.
Non-private insurance was also associated with reduced physical HRQL. Interestingly, women with a low perception of being informed about their treatment reported improved physical health—an unexpected finding that warrants further investigation.
The study authors noted that these disparities in mental health outcomes may reflect the intersection of clinical burden, systemic inequities, and limited access to psychosocial support following DCIS treatment.
“Interventions aimed at improving mental health outcomes for at-risk DCIS patients are a crucial next step,” the authors concluded.
These findings add to the growing recognition that long-term survivorship care must address not only physical recovery but also psychological well-being, particularly for patients experiencing structural disadvantage.
Paper: Dunsmore VJSnyder BSGareen IF, et al. Quality of Life Among Patients With Ductal Carcinoma In Situ. JAMA Netw Open. 2025;8(7):e2518887. doi:10.1001/jamanetworkopen.2025.18887
