Impact of ductal carcinoma in situ terminology on patient treatment preferences.

Impact of Ductal Carcinoma In Situ Terminology on Patient Treatment Preferences Ductal carcinoma in situ (DCIS) is a preinvasivemalignancyof thebreast and isdiagnosed inmore than50 000womenayear in the United States. It is treated with either mastectomy or lumpectomy, often combinedwith radiation therapy.1 In cases of low-grade DCIS, studies suggest that if progression occurs, it does so within a time frameof 5 to40 years2 and possibly in only 20%ofDCIS cases.3 This raises the possibility that some cases ofDCISwill followan indolent course thatwill not attain clinical significance during the patient’s lifetime. Accordingly, watchfulwaitinghasbeenproposedas a reasonableoption for DCIS,4 akin towhat is currently offered for patientswith early stageprostatecancer;however,howto implement suchastrategy is unclear. Manywomen are unable to distinguish between preinvasive and invasive cancer and often overestimate the implicationsof aDCISdiagnosis.5 Thesemisperceptionsmaydrivepatients’ willingness for invasive treatments. Health care providers’ communicationwith theirpatientsaboutDCISplays an important role in patients understanding the risks of their diagnosis. Terms such as carcinoma, stage-0 cancer, and noninvasive cancer are commonly used to describe DCIS andmay further contribute to the confusion engendered in many patients.6 Given the inconsistent terminology used for DCIS, wehypothesized thatwhenDCIS isdescribedwithout the term cancer,womenwouldbemore likely toopt fornoninvasiveapproaches such as medication or watchful waiting in place of surgery.