Ductal Carcinoma In Situ: What We Call It Matters

Summary and Comment |
September 3, 2013

Ductal Carcinoma In Situ: What We Call It Matters

  1. Andrew M. Kaunitz, MD

Avoiding the word “cancer” prompted women's choice of noninvasive management.

  1. Andrew M. Kaunitz, MD

In her famous utterance, Juliet asked, “What's in a name?” Many of my patients do not distinguish between preinvasive and invasive cancer and misjudge the clinical implications of the term “ductal carcinoma in situ” (DCIS). Investigators speculated that describing DCIS without using the term “cancer” makes women more comfortable opting for noninvasive approaches over surgery. A total of 394 healthy women without histories of breast cancer were presented with three vignettes in which DCIS was described using the terms “noninvasive breast cancer,” “breast lesion,” or “abnormal cells” (treatment options and likelihood of developing invasive breast cancer or death were identical). Women then chose among surgery, medication, or active surveillance as treatment options.

Overall, medication or active surveillance was selected more often than surgery. When the term “noninvasive cancer” was used, 53% of participants chose nonsurgical management. In contrast, when the terms “breast lesion” or “abnormal cells” were used, 66% and 69% of participants, respectively, chose nonsurgical management.

Comment

Ductal carcinoma in situ is a preinvasive malignancy of the breast that is diagnosed in >50,000 U.S. women annually and is often treated with lumpectomy and radiation therapy or mastectomy. However, because DCIS will not necessarily lead to clinical disease in a patient's lifetime, watchful waiting may be a reasonable option. Consistent with the National Cancer Institute's recent recommendation, these results suggest that when descriptions of DCIS do not involve the term “cancer,” a large majority of women choose nonsurgical treatments. The authors note that the study population was highly educated with higher-than-average incomes, limiting generalizability. Nonetheless, the findings illustrate that the way in which we describe medical conditions can have a powerful effect on our patients' perceptions and subsequent choices, leading some women to unnecessary surgery. What's in a name? For DCIS, think twice before saying “cancer.”

Editor Disclosures at Time of Publication

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Agile; Bayer; Merck Equity Vertex Royalties UpToDate Grant / research support Agile; Bayer; Endoceutics; Medical Diagnostic Laboratories; Noven; Teva Editorial boards Contraception; MedScape; Menopause; OBG Management Leadership positions in professional societies North American Menopause Society (Board of Trustees)

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