Did you know that Ductal Carcinoma In Situ (DCIS), noninvasive breast cancer, breast lesion or abnormal cells have all the same meaning? A very recent study from a team of the University of California San Francisco (UCSF) describes the impact of complicated medical terminology on patient treatment preference.

Since medical terms may sometimes sound too complicated and cryptic, health care provider’s communication with their patients is critical for a full understanding of medical conditions, diagnosis and treatments. In the research letter published on JAMA Internal Medicine on August 26^th, Ozanne M. et al.¹ explored the effect of Ductal Carcinoma In Situ (DCIS) terminology on the choice of patient treatment.

DCIS is the most common type of non-invasive breast cancer, accounting for the 20-25% of newly diagnosed breast cancers in the United States. It is treated with mastectomy or lumpectomy, with or without radiation therapy, and with or without adjuvant hormonal therapy². In some low-grade cases, the progression may occur in a very long time frame (5 to 40 years), with no relevant clinical significance during patient’s life. Therefore, in these cases a watchful waiting period has been proposed instead of a treatment, even if it might be difficult to convince of this a patient who has just discovered to have “cancer”.

The team of doctors from UCSF hypothesized that without using the word cancer, the women diagnosed with DCIS might be more prone to non-invasive approaches. They surveyed 394 healthy women with no history of breast cancer and presented them 3 scenarios to describe the diagnosis of DCIS: noninvasive breast cancer, breast lesion or abnormal cells. To all of them was presented the same outcomes and options of treatment (surgery, medication, or active surveillance). They found that when DCIS was described as a high risk condition (breast lesion, or abnormal cells) instead of a cancer, more that 66% of women chose non-surgical treatments, whereas when the term noninvasive cancer was used only 53% of the participants chose a non-surgical option.

As pointed out in the original article, the current study has some limitations, being performed on a restricted cohort of educated and well insured women, different from the cohort of DCIS patients, and without taking into account specific factors, such as tumor grade and age. Although this analysis was performed on healthy women who didn’t have cancer, it suggests that many patients may prefer noninvasive therapies, when allowed to carefully consider risks and treatments, pointing out the importance of the terminology used by health care providers.

Too often, people are confused after leaving their physician’s office and this is something that should not happen, especially when dealing with serious and heterogeneous diseases, such as cancer. Hopefully this study is not a drop in the bucket and will be taken into consideration in the future, leading to a careful elucidation of the puzzling medical dictionary.

1              Omer, Z. B., Hwang, E. S., Esserman, L. J., Howe, R. & Ozanne, E. M. Impact of Ductal Carcinoma In Situ Terminology on Patient Treatment Preferences. JAMA Intern Med, doi:10.1001/jamainternmed.2013.84051731962 [pii] (2013).

2              Virnig, B. A., Wang, S. Y., Shamilyan, T., Kane, R. L. & Tuttle, T. M. Ductal carcinoma in situ: risk factors and impact of screening. J Natl Cancer Inst Monogr 2010, 113-116, doi:10.1093/jncimonographs/lgq024lgq024 [pii] (2010).