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Labels may affect decision-making for breast lesions

By Genevra Pittman

NEW YORK (Reuters Health) - How doctors describe a non-invasive type of breast lesion may affect how women choose to have the abnormal cells treated, a new survey suggests.

Ductal carcinoma in situ, or DCIS, accounts for about one in every five new breast cancer diagnoses in the United States when it's included in cancer statistics. DCIS may spread and become invasive cancer, but is not life-threatening on its own - and some researchers question whether it should be called "cancer" at all.

Still, most women with DCIS undergo breast-conserving surgery or a mastectomy. The new findings suggest doctors using the phrase "non-invasive cancer" to describe DCIS, rather than "breast lesion," for example, may be one reason women tend to go that route.

"I think it's often the case that patients hear the word ‘cancer' and that's all they really take in, and the non-invasive component is missed," Elissa Ozanne, who worked on the study at the University of California, San Francisco, said.

"Certain terminologies can confer potentially unintended messages," she told Reuters Health.

"Having DCIS puts you at higher risk for invasive breast cancer, but it's not at all the same as having invasive cancer," Heather Gold, a breast cancer researcher and associate professor at the New York University School of Medicine, said.

"If we're overdiagnosing this and calling it cancer, then we're also in turn overtreating," she said.

Some women with DCIS can be treated with medications such as tamoxifen or managed with so-called active surveillance - regular screening to make sure the cancer hasn't become invasive - the researchers said.

For their study, Ozanne and her colleagues surveyed 394 healthy women on what treatment they would choose if diagnosed with a hypothetical condition. Women were presented with the same table of possible outcomes and treatment options for a "non-invasive breast cancer," a "breast lesion" or "abnormal cells" - all ways to describe DCIS.

Surgery was the most popular option for a hypothetical "non-invasive breast cancer." Just under half of women picked surgery in that scenario, while one-third opted for active surveillance.

Those proportions flipped when the diagnosis was given instead as a "breast lesion" or "abnormal cells," according to the findings published this week in JAMA Internal Medicine.

"Some people think that the time frame over which DCIS might progress (to invasive cancer) can be anywhere from five to 40 years for the low-grade cancer," Ozanne said. "In some cases it may be many, many years before something progresses, and many cases are thought not to progress."

Gold, who was not involved in the new study, called it "very timely."

"A lot of women with DCIS assume they have cancer. Women who think it's cancer are more likely to be more aggressive with their treatment," when they might have been able to avoid surgery completely, she told Reuters Health.

"We have this problem of overdiagnosis, and that is followed by overtreatment."

The researchers noted their survey was based on hypothetical diagnoses, and did not include women with DCIS, who might have answered the survey questions differently.

Gold said women who are diagnosed with DCIS should discuss the possible risks with their doctor and make sure they fully understand the intricacies of their diagnosis. Some types of DCIS are very aggressive and can grow quickly, she said, while others typically do not.

SOURCE: http://bit.ly/KEPNSw JAMA Internal Medicine, online August 26, 2013.

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