Words matter when guiding DCIS treatment

Not using the word “cancer” to describe abnormal cells in the breast can prevent women from panicking or pursuing overly aggressive treatment for a common pre-invasive breast cancer.

That’s the finding of a study of Australian women with ductal carcinoma in situ (DCIS) published in BMJ Open. The condition often is detected by mammogram and treated with mastectomy or lumpectomy combined with radiation, but the researchers say there is growing evidence that providers may be overtreating women with DCIS. Some women with DCIS have such slow-growing abnormal cells that surgery or radiation can do more harm than good, the researchers wrote.

Less aggressive approaches such as hormone therapy or active surveillance may be appropriate for some patients with DCIS, said the researchers, led by Kirsten McCaffery, PhD, of the University of Sydney. The incidence rate of DCIS has been rising and DCIS represents about 20 percent of cancers detected by screening. “Although DCIS is divided into three grades with different rates of progression, it is almost always treated as if it were invasive cancer,” the authors wrote.

Helping women make the best treatment decisions can hinge on the language used. The researchers tested the impact of language by presenting 269 women with two hypothetical scenarios: one calling the condition “abnormal cells,” the other calling it “pre-invasive breast cancer cells.”

Of the women 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.”

When women first told about “abnormal cells” then were presented with the “pre-invasive breast cancer cells” language, 55 percent still favored watchful waiting.

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.

Approximately two-thirds of the women who first heard “abnormal cells” said they would be more concerned with the second alternative, which called the condition “cancer.”

The authors acknowledged that the study is hypothetical and women could have a different response in a real-life scenario.

“The findings provide evidence that further investigation of the effects of changing DCIS terminology is needed in clinical populations as removing the cancer term may reduce concern and overtreatment," wrote McCaffery and colleagues. "At minimum it shows that language is a powerful tool that has the potential to shape both understanding and actions.”