Breast cancer terminology: How doctors' words can influence patient choices
Published Tuesday, August 27, 2013 11:20AM EDT
Last Updated Tuesday, August 27, 2013 12:17PM EDT
The wording that doctors use when they tell a woman that she has an early form of breast cancer might influence her decision about whether to treat it with surgery, a new study suggests.
The research looked at women diagnosed with “ductal carcinoma in situ” (DCIS), a precursor to invasive cancer that’s sometimes called Stage 0 cancer. DCIS is a condition in which abnormal cells have been found in the breast duct lining. It’s typically too small to be felt during a breast exam and is most often spotted during a mammogram.
While DCIS puts women at risk for future invasive breast cancer, DCIS itself is not invasive. In fact, studies have shown that only 20 per cent of DCIS cases eventually become invasive breast cancer, and that progression, if it occurs, can take five to 40 years.
This latest study looked at how women would react to news they had DCIS. Researchers led by Zehra B. Omer, a medical student working at Massachusetts General Hospital, recruited 394 healthy women without a history of breast cancer and presented them with three DCIS diagnosis scenarios:
- one called it a non-invasive breast cancer – a term that still uses the word “cancer”
- another called DCIS a “breast lesion”
- the final scenario called it a finding of “abnormal cells”
After each scenario, the women chose three treatment options: surgery, medication, or active surveillance, also known as “watchful waiting.” The researchers then counted how many women chose a non-surgical option.
They found the results varied based on the terminology the women heard:
- when DCIS was described as a non-invasive cancer, only 53 per cent chose a non-surgical treatment
- when “breast lesion” was used, 66 per cent chose the non-surgical options
- when the term was “abnormal cells,” 66 per cent preferred nonsurgical options
“We conclude that the terminology used to describe DCIS has a significant and important impact on patients’ perceptions of treatment alternatives,” the study authors write in the journal, JAMA Internal Medicine.
They add that doctors who use the word “cancer” to describe DCIS should ensure that patients really understand how DCIS is distinct from invasive cancer.
CTV medical specialist Dr. Marla Shapiro, who was not involved in the research, says the study is an important look at how important it is for patients to have “informed consent” before they make treatment decisions. She says it’s also important that women understand that breast cancer is not a “homogenous” disease.
“There are many, many different types of breast cancer,” Shapiro told CTV’s Canada AM Tuesday. “And the first question to ask is: is it invasive, is it non-invasive? What are all the treatment options available to me, and what are the pros and cons? That’s the best way to make a decision.”
This study was supported by the American Cancer Society.