When ductal carcinoma in situ (DCIS, a preinvasive malignancy of the breast) is described as a high-risk condition rather than cancer, more women report that they would opt for nonsurgical treatments, according to recently published research.
The research letter, published in JAMA Internal Medicine (2013; doi:10.1001/jamainternmed.2013.8405), stated that more than 50,000 women a year in the United States are diagnosed with DCIS. It is treated with either mastectomy or lumpectomy, and these are often combined with radiation therapy. Studies have suggested that if progression of low-grade DCIS does occur, the time frame is 5 to 40 years and the progression may only occur in 20% of DCIS cases. So, some cases of DCIS are likely to follow an indolent course, which does not reach clinical significance during the patient’s lifetime.
The study’s authors suggested that many women cannot distinguish between preinvasive and invasive cancer, and so they may overestimate the implications of a DCIS diagnosis. Misconceptions may drive a patient’s willingness for invasive treatments. The researchers conducted their study to explore the hypothesis that when DCIS is described without using the term cancer, women would be more likely to opt for noninvasive approaches or watchful waiting instead of surgery.
A total of 394 healthy women without a history of breast cancer participated in the study and were presented with three scenarios that described a diagnosis of DCIS as noninvasive breast cancer, breast lesion, or abnormal cells. After each scenario, the women chose among three treatment options: surgery, medication, or active surveillance.
Overall, the nonsurgical options of medication and active surveillance were more frequently selected over surgery. When DCIS was described using the term noninvasive cancer, 53% preferred nonsurgical options, whereas 66% preferred nonsurgical options when the term was breast lesion and 69% preferred nonsurgical options when the term was abnormal cells. Significantly more women changed their preference from a surgical to a nonsurgical option than from a nonsurgical to a surgical option depending on terminology, according to the study results.
The study concluded that, “The terminology used to describe DCIS has a significant and important impact on patients’ perceptions of treatment alternatives. 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.”