Women told they have breast 'cancer' more likely to want surgery

Women were more likely to want surgery when they were told they had a type of breast cancer than when the diagnosis was a breast lesion or a group of abnormal cells — even though all three scenarios described the same disease. The findings, reported Monday in the journal JAMA Internal Medicine, offer a new way to gauge the power of the word “cancer.”

The words doctors use to tell a woman she has ductal carcinoma in situ can make a big difference in the treatment she chooses. Ductal carcinoma in situ, or DCIS, can be an early form of breast cancer. But in many cases, the tumor never grows beyond the milk duct where it was found. If it does invade the surrounding breast tissue, it can take as long as 40 years to do so.

All that uncertainty has led doctors to describe DCIS in a variety of ways. Sometimes they tell women that it’s a stage 0 cancer, or that it’s a noninvasive tumor. “Carcinoma” itself is synonymous with cancer. Just a few weeks ago, an expert panel convened by the National Cancer Institute recommended that the name for DCIS be changed to something that sounds less threatening. As they explained in an editorial published in the Journal of the American Medical Assn.:

“The word ‘cancer’ often invokes the specter of an inexorably lethal process; however, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime.”

For the new study, researchers from UC San Francisco, Massachusetts General Hospital and Duke University Medical Center recruited 394 women who were in fine health and asked them to imagine they were diagnosed with DCIS. The diagnosis was presented three ways: as “noninvasive breast cancer,” a “breast lesion” or “abnormal cells.”

In all three cases, the treatment options and outcomes were the same. Yet there were clear differences in the way women reacted:

Ductal carcinoma in situ (DCIS) is a noninvasive condition. DCIS can progress to become invasive cancer, but estimates of the likelihood of this vary widely. Some people include DCIS in breast cancer statistics. The frequency of the diagnosis of DCIS has increased markedly in the United States since the widespread use of screening mammography. In 1998, DCIS accounted for about 18% of all newly diagnosed invasive plus noninvasive breast tumors in the United States.

Very few cases of DCIS present as a palpable mass; 80% are diagnosed by mammography alone. DCIS comprises a heterogeneous group of histopathologic lesions that have been classified into several subtypes based primarily on architectural pattern: micropapillary, papillary, solid, cribriform, and comedo. Comedo-type DCIS consists of cells that appear cytologically malignant, with the presence of high-grade nuclei, pleomorphism, and abundant central luminal necrosis. Comedo-type DCIS appears to be more aggressive, with a higher probability of associated invasive ductal carcinoma.