What's in a Breast Cancer's Name?

Ductal carcinoma in situ treatment decisions vary according to terminology used

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) For some prostate cancers, taking a wait-and-see approach is the best option. That’s because many of these cancers won’t ever become life-threatening. This same approach may be appropriate for and preferred by women with a specific type of breast tumor.

Ductal carcinoma in situ (DCIS) is a tumor that develops in the breast’s ducts, the vessels that carry milk. “In situ” means that it hasn’t started to spread beyond the duct.

Recent research found that when the word “cancer” was not used to describe ductal carcinoma in situ, most women chose treatment plans that didn’t include surgery.

"Research your cancer treatment options."

Zehra B. Omer, BA, of Massachusetts General Hospital—Institute for Technology Assessment in Boston, and colleagues conducted this study to see how terminology impacted a woman’s DCIS treatment choices.

In the article’s introduction, the authors noted that possibly only 20 percent of low-grade DCIS get worse, and progression typically occurs within five to 40 years, if at all.

Yet, DCIS is often treated with surgical removal of the breast (mastectomy) or lumpectomy (surgical removal of the tumor and surrounding tissue) and radiation.

The research team pointed out that physicians often use confusing terms to describe DCIS, such as carcinoma, stage-O cancer and noninvasive. Many women often don’t understand these terms.

The researchers wanted to test what would happen if different words were used to describe DCIS. Their theory was that if the word “cancer” wasn’t used, women would opt for nonsurgical treatment which includes watchful waiting or medication instead of surgery.

For this study, 394 women with no history of breast cancer were offered three different scenarios that described DCIS as “noninvasive breast cancer,” “breast lesion,” or “abnormal cells.”

The women were then given the opportunity to choose between three different treatments: surgery, medication or active surveillance in which the tumor is carefully watched over time.

Depending on the terms used, most women decided against surgery:

  • When the term “noninvasive breast cancer" was used, 53 percent chose nonsurgical treatment.
  • 66 percent chose watchful waiting or medication over surgery when the term “breast lesion” was used.
  • When described as “abnormal cells,” 69 percent of the women opted for nonsurgical interventions.

“We conclude that the terminology used to describe DCIS has a significant and important impact on patients’ perceptions of treatment alternatives," the authors wrote.

Adam M. Brufsky, MD, PhD, professor of medicine at the University of Pittsburgh School of Medicine, treats a number of women with ductal carcinoma in situ. “This is interesting work and really gets us thinking about the nature of DCIS and how to explain it to patients," he told dailyRx News.

Dr. Brufsky said that he agreed with the approach of possibly eliminating the word “cancer” when describing DCIS, and added, “I think it is something we are going to mull over in the next year.”

This research letter was published August 26 in JAMA Internal Medicine.

The work was funded by the American Cancer Society. None of the authors reported a potential conflict of interest.

Review Date: 
August 26, 2013
Last Updated:
August 26, 2013