Women Panic Less When DCIS Is Not Called Cancer
NEW YORK (Reuters Health) – Women may be less likely to panic or pursue aggressive treatment for ductal carcinoma in situ (DCIS) if clinicians don’t use the word “cancer” to describe the abnormal cells, an Australian study suggests.
“There is growing evidence that we may be overtreating women with DCIS and that less aggressive approaches such as hormone-based therapy alone or active surveillance (also called watchful waiting) may be appropriate for some women with this diagnosis,” lead author Dr. Kirsten McCaffery of the University of Sydney told Reuters Health by email.
Diagnosis of DCIS has climbed along with rising breast cancer screening rates, and this diagnosis now represents about 20% of screen-detected cancers, Dr. McCaffery and colleagues write in an article online November 2 in BMJ Open.
One of the challenges in guiding women to make the best treatment decisions is what to call this type of cancer and how to describe it, the authors point out.
To test how the name for DCIS impacts patients’ level of concern about the diagnosis and their treatment preferences, researchers presented a group of 269 women with two hypothetical scenarios: one calling the condition “abnormal cells” and another calling it “pre-invasive breast cancer cells.”
Women were randomly chosen to get one scenario first, then the second alternative description.
Among women who were told about “abnormal cells” first, 67% said they preferred watchful waiting instead of treatment, compared with 60% of the women who were first told about “pre-invasive breast cancer cells.”
Then, when women initially told about “abnormal cells” heard the alternative terminology using the word “cancer,” the proportion that still favored watchful waiting dropped to 55%.
The women initially told about “pre-invasive breast cancer cells” also became slightly less inclined toward watchful waiting once they heard the alternative wording: 59% of them favored waiting when they heard the “abnormal cells” scenario.
In addition, 67% of the women who initially heard the words “abnormal cells” said they would be more concerned with the second alternative, which called the condition “cancer.”
The study is hypothetical, and women might respond differently when presented with a real-life diagnosis, the authors acknowledge.
Even so, the authors argue that the findings point to a potential for descriptions of the diagnosis without the word “cancer” to help curb unnecessary treatments.
“The word ‘cancer’ in whatever format carries an aura that we have grown up with to be associated with bad news; so, using the medicalized term ‘carcinoma’ tends to emphasize the need for action and radical action at that in some people’s minds,” Dr. Alastair Thompson, a researcher in breast surgical oncology at the University of Texas MD Anderson Cancer Center in Houston, told Reuters Health by email.
“The terminology is confusing for all parties,” Dr. Thompson said. “An individual woman should be asking the type of changes going on.”
The National Health and Medical Research Council supported this research. The authors reported no disclosures.
BMJ Open 2015.