Terminology used to describe ductal carcinoma in situ impacts patient preferences

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1. When the term cancer is used to describe ductal carcinoma in situ (DCIS), significantly more patients chose surgical management compared to medical management or active surveillance. 

2. If DCIS is described as a lesion or as abnormal cells, significantly more women chose active surveillance than medication or surgery. 

Evidence Rating Level: 3 (Average) 

Study Rundown: Ductal carcinoma in situ (DCIS) is a pre-cancerous lesion diagnosed in approximately 50,000 women yearly. Furthermore, despite the frequency at which it is diagnosed it only progresses to cancer in 1 out of every 5 women over the course of up to 40 years. It has been found that the terminology used to deliver the diagnoses to patients influences their treatment decisions. Women in this study were presented with 3 case scenarios that described a case of DCIS using the terms “noninvasive breast cancer”, “breast lesion” or “abnormal cells”.  They were given a number of treatment options with identical outcomes including surgery, medication or watchful waiting.  Significantly more women opted for surgery when the term “cancer” was used in the diagnosis compared to medical management or active surveillance whereas when the word “lesion” or “abnormal cells” were used, more women opted for active surveillance (p <.001). One drawback to this study was that the group of women was otherwise healthy and did not have a diagnosis of DCIS. Therefore, the reaction of women might have been more heavily influenced if they carried the diagnosis of DCIS. Overall, the study suggests that when the word cancer is avoided, there is a higher likelihood of women choosing active surveillance compared to surgery.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Ductal carcinoma in situ: terminology, classification, and natural history

In-Depth [randomized case-control study]: This study looked at the impact of terminology used for the description of ductal carcinoma in situ on the patient treatment preferences and included 394 women without a history of breast cancer. Three treatment options were given, surgery, medication or active surveillance all with the same outcomes. When the word “cancer” was used, 47% of the women opted for surgery compared to 20% for medication and 33% for active surveillance (p= <.001).  However if the word “cancer” was avoided and the word “lesion” or “abnormal cells” were used, 48% opted for active surveillance in both groups (p= <.001). Also, women with a history of non-breast cancer and higher socioeconomic status were more likely to choose surgery.

By Camellia Banerjee and Brittany Hasty

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