Background: Each year in the United States, about 54,000 women are diagnosed with ductal carcinoma in situ (DCIS). Most diagnoses are by screening mammography in asymptomatic women. Many women have small, low-grade lesions, and almost all are treated surgically. More than 50% of these women may be overdiagnosed. Objective: To characterize psychosocial harms of DCIS diagnosis and treatment. Understanding these harms might facilitate development of interventions to improve wellbeing in these women. Data Sources: MEDLINE, CINAHL, PsycINFO and Cochrane Library databases, reference lists, forward citation searches Study Selection: Studies evaluating psychosocial outcomes in adult women diagnosed and/or treated for DCIS were included. Data Extraction: Two reviewers assessed study quality using methods adapted from the United States Preventive Services Task Force and the Clinical Skills Assessment Programme. One reviewer abstracted data, and a second reviewer verified abstraction. Data Synthesis: Fifteen articles describing eight studies met inclusion criteria, including four prospective cohort studies, two cross-sectional studies, and two qualitative studies. Key findings include a clinically significant impact on quality of life in the first six months after diagnosis, and intrusive thoughts and fear of recurrence that commonly persist at least 18-24 months. Limitations: We include only a subset of the potential harms of DCIS. We do not consider studies of invasive breast cancers. Threats to internal validity included lack of power analyses, multiple statistical comparisons, and non-validated instruments. Few studies have assessed effects of diagnosis (labeling) independent of treatment. No studies meeting eligibility criteria have assessed interventions to improve wellbeing. Conclusions: Women with DCIS appear to experience clinically significant effects on wellbeing. Additional good quality longitudinal studies are needed to characterize the nature and burden of psychosocial harms experienced by these women.Master of Public Healt
