Women seem less likely to chose surgery for a preinvasive lesion of the breast depending on how the condition is described, researchers propose.
Ductal carcinoma in situ or DCIS is a "preinvasive malignancy" that could cause no harm during the patient's lifetime. Doctors have proposed watchful waiting for DCIS but it's unclear how to implement the strategy. For some clues, researchers surveyed women about the choices they would make when the condition is described using different terminology.
When DCIS was described to 394 healhy U.S. women without a history of breast cancer using the term noninvasive cancer, 53 per cent (208 of 394) preferred nonsurgical options, researchers said in today's issue of JAMA Internal Medicine.
In comparison, 66 per cent (258 of 394) preferred nonsurgical options when the term was breast lesion and 69 per cent (270 of 394) preferred nonsurgical options when the term was abnormal cells.
"We conclude that the terminology used to described DCIS has a significant and important impact on patients' perceptions of treatment alternatives," Zehra Omer of Massachusetts General Hospital — Institute for Technology Assessment and her co-authors said in their research letter.
"Health care providers who use 'cancer' to describe DCIS must be particularly assiduous in ensuring that patients understand the important distinctions between DCIS and invasive cancer."
In the survey, participants were reminded that risks (developing invasive breast cancer and death) and benefits were the same for all three scenarios describing the diagnosis. The order of scenarios was varied randomly across participants.
The participants were highly educated and numerate with higher than average income. It's possible that patients with DCIS could respond differently than those in the survey, the researchers said.
For DCIS patients, factors such as age and tumour grade are also important compared with the general scenarios in the survey.
Last month, Dr. Laura Esserman of the University of California, San Francisco, one of the authors of the latest paper, proposed that the definition of cancer should be narrowed to exclude some forms of the disease that are unlikely to cause harm, including DCIS. The JAMA commentary was based on recommendations from a working group of the U.S. National Cancer Institute.