What's in a name: Describing ductal carcinoma in situ (DCIS).

Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy
Session Type and Session Title: 
This abstract will not be presented at the 2014 ASCO Annual Meeting but has been published in conjunction with the meeting.
Abstract Number: 
J Clin Oncol 32, 2014 (suppl; abstr e12020)
Lesley Fallowfield, Valerie A Jenkins, Lucy Matthews, Adele Francis, Daniel Rae; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; University of Birmingham, Birmingham, United Kingdom

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Abstract Disclosures


Background: Despite aggressive management of DCIS invasive breast cancer incidence continues to rise. Data suggest that many women, especially those with screen detected low and intermediate grade DCIS, may be over treated. In the absence of definitive data about its natural history and consequently true risks of ever becoming invasive cancer, is it even appropriate to describe DCIS as cancer at all? A new trial in the UK, LORIS (Low Risk DCIS), compares surgery with active monitoring. Recruitment is likely to be challenging as the word carcinoma in DCIS may lead women to think that they have breast cancer, so clinicians must describe the condition in a balanced manner. We conducted a survey amongst the multidisciplinary British Breast Group (BBG), to determine which descriptions of low grade DCIS should be used when discussing the LORIS trial with patients. Methods: Attendees at the February 2013 BBG meeting participated in a questionnaire survey comprising 5 short descriptions adapted from UK cancer charities’ websites and one designed by the LORIS Trial Management Group (TMG). Respondents indicated if they would feel comfortable using each description with patients, then to state their most preferred and most disliked descriptions. Results: 54/73 (74%) attendees completed the survey: surgeons (41%), oncologists (24%), radiologists (13%), scientists (12.9%), pathologists (5.5%), other (3.6%). A majority (34/54; 63%) said they would be comfortable using the description which explained DCIS as abnormal cells in the milk ducts that had not spread into other breast tissue and which did not need urgent treatment as if it was breast cancer. This one, devised by the LORIS TMG was also the most preferred description (24/54; 44%). Portrayal of DCIS as the earliest possible form of breast cancer was the least preferred description (17/54; 31%). Conclusions: Little consensus exists regarding how best to explain low grade DCIS to patients. Cancer charity websites and clinicians use different terms. There is an urgent need when discussing DCIS trials, especially those with an active monitoring arm, to use consistent, accurate but non-alarming terminology avoiding the use of the words ‘early breast cancer’.