Women panic less when abnormal breast cells are not called cancer

Women may be less likely to panic or pursue aggressive treatment for a common, non-invasive breast tumor if doctors don't use the word "cancer" to describe the abnormal cells, an Australian study suggests.

Researchers focused on a pre-invasive malignancy of the breast known as ductal carcinoma in situ (DCIS) that is often detected by mammograms and treated with a mastectomy or with a lumpectomy paired with radiation.

"There is growing evidence that we may be overtreating women with DCIS and that less aggressive approaches such as hormone-based therapy alone or active surveillance (also called watchful waiting) may be appropriate for some women with this diagnosis," lead study author Kirsten McCaffery of the University of Sydney said by email.

Diagnosis of DCIS has climbed along with rising breast cancer screening rates, and this diagnosis now represents about 20 percent of screen-detected cancers, McCaffery and colleagues write in the journal BMJ Open.

While some women with this diagnosis may benefit from aggressive treatment to prevent or stall the development of more dangerous types of breast cancer, many women have abnormal cells that are so slow-growing that surgery or radiation can do more harm than good, the researchers note.

One of the challenges in guiding women to make the best treatment decisions is what to call this type of cancer and how to describe it, the authors argue.

To test how the name for DCIS impacts patients' level of concern about the diagnosis and their treatment preferences, researchers presented a group of 269 women with two hypothetical scenarios: one calling the condition "abnormal cells" and another calling it "pre-invasive breast cancer cells."

Women were randomly chosen to get one scenario first, then the second alternative description.

Among women who were 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."

Then, when women initially told about "abnormal cells" heard the alternative terminology using the word "cancer," the proportion that still favored watchful waiting dropped to 55 percent.

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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.

In addition, 67 percent of the women who initially heard the words "abnormal cells" said they would be more concerned with the second alternative, which called the condition "cancer."

The study is hypothetical, and women might respond differently when presented with a real-life diagnosis, the authors acknowledge.

Even so, the authors argue that the findings point to a potential for descriptions of the diagnosis without the word "cancer" to help curb unnecessary treatments.

"The word `cancer' in whatever format carries an aura that we have grown up with to be associated with bad news; so, using the medicalised term `carcinoma' tends to emphasize the need for action and radical action at that in some people's minds," said Dr. Alastair Thompson, a researcher in breast surgical oncology at the University of Texas MD Anderson Cancer Center in Houston.

To make an informed decision, women should ask doctors whether the abnormal cells are confined to the breast tubes - ducts and lobules - or in surrounding breast tissue, Thompson, who wasn't involved in the study, said by email. Women should also ask how large the abnormal area is, whether the abnormal cells can be felt or only seem with imaging scans, and how the cells look.

"The terminology is confusing for all parties," Thompson said. "An individual woman should be asking the type of changes going on."