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 Researchers focused on a pre-invasive malignancy of the breast known
as ductal carcinoma in situ (DCIS) that is often detected by
mammograms and treated with a mastectomy or with a lumpectomy paired
with radiation.
“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 study
author Kirsten McCaffery of the University of Sydney said by email.
Diagnosis of DCIS has climbed along with rising breast cancer
screening rates, and this diagnosis now represents about 20 percent
of screen-detected cancers, McCaffery and colleagues write in the
journal BMJ Open.
While some women with this diagnosis may benefit from aggressive
treatment to prevent or stall the development of more dangerous
types of breast cancer, many women have abnormal cells that are so
slow-growing that surgery or radiation can do more harm than good,
the researchers note.
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 argue.
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 percent
said they preferred watchful waiting instead of treatment, compared
with 60 percent 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 percent.
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 percent of them favored waiting
when they heard the “abnormal cells” scenario.
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In addition, 67 percent 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
medicalised term `carcinoma’ tends to emphasize the need for action
and radical action at that in some people’s minds,” said Dr.
Alastair Thompson, a researcher in breast surgical oncology at the
University of Texas MD Anderson Cancer Center in Houston.
To make an informed decision, women should ask doctors whether the
abnormal cells are confined to the breast tubes – ducts and lobules
– or in surrounding breast tissue, Thompson, who wasn’t involved in
the study, said by email. Women should also ask how large the
abnormal area is, whether the abnormal cells can be felt or only
seem with imaging scans, and how the cells look.
“The terminology is confusing for all parties,” Thompson said. “An
individual woman should be asking the type of changes going on.”
SOURCE: http://bit.ly/1Qix9CM BMJ Open, online November 2, 2015.
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