DESCRIPTION OF DCIS AND CHOICE OF TREATMENT

In a study reported in a research letter inJAMA Internal Medicine, Zehra B. Omer, BA, of Massachusetts General Hospital, and colleagues assessed how the description of ductal carcinoma in situ (DCIS) affected selection of treatment options. They found significant differences in treatment choices based on description, with more subjects selecting noninvasive options when “cancer” was not included in the description.

Study Details

The study involved a survey of 394 healthy women without a history of breast cancer. Subjects were presented with scenarios that described a diagnosis of DCIS as (1) “noninvasive breast cancer,” (2) “breast lesion,” or (3) “abnormal cells.” Each scenario and an accompanying list of treatment options and outcomes of treatment (ie, chance of developing invasive breast cancer or death) were identical apart from the term used for DCIS. Subjects chose from among the three treatment options of surgery, medication, and active surveillance. The study cohort was highly educated, numerate, well insured, and had an income level higher than average.

Treatment Choices

The investigators found significant differences in the treatment choices according to the three scenarios (P < .001). When DCIS was described as “noninvasive cancer,” 47% of subjects selected surgery as their treatment preference, 20% selected medication, and 33% selected active surveillance. When DCIS was described as “breast lesion,” 34% selected surgery, 18% medication, and 48% active surveillance. When DCIS was described as “abnormal cells,” 31% selected surgery, 21%, medication, and 48% active surveillance.

History of cancer other than breast cancer and high socioeconomic status were significantly associated with selection of surgery on univariate analysis but not on multivariate analysis. High numeracy was the sole independent predictor of selection of surgery in all three scenarios, with odds ratios of 2.11 (P= .001) for “noninvasive cancer,” 1.96 (P = .007) for “breast lesion,” and 1.63 (P = .048) for “abnormal cells.”

The authors concluded: “We found that when DCIS is framed as a high-risk condition rather than as cancer, more than 65% of women opt for nonsurgical treatments…. [T]he terminology used to describe DCIS has a significant and important impact on patients’ perceptions of treatment alternatives. Health care providers who use ‘cancer’ to describe DCIS must be particularly assiduous in ensuring that patients understand the important distinctions between DCIS and invasive cancer.”

Elissa M. Ozanne, PhD, of University of California, San Francisco, is the corresponding author for theJAMA Internal Medicine research letter.