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Research Letter |

Impact of Ductal Carcinoma In Situ Terminology on Patient Treatment Preferences

Zehra B. Omer, BA1; E. Shelley Hwang, MD, MPH2; Laura J. Esserman, MD, MBA3; Rebecca Howe, BA3; Elissa M. Ozanne, PhD3
[+] Author Affiliations
1Massachusetts General Hospital–Institute for Technology Assessment, Boston
2Department of Surgery, Duke University Medical Center, Durham, North Carolina
3Department of Surgery, University of California, San Francisco
JAMA Intern Med. 2013;173(19):1830-1831. doi:10.1001/jamainternmed.2013.8405.
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Ductal carcinoma in situ (DCIS) is a preinvasive malignancy of the breast and is diagnosed in more than 50 000 women a year in the United States. It is treated with either mastectomy or lumpectomy, often combined with radiation therapy.1 In cases of low-grade DCIS, studies suggest that if progression occurs, it does so within a time frame of 5 to 40 years2 and possibly in only 20% of DCIS cases.3 This raises the possibility that some cases of DCIS will follow an indolent course that will not attain clinical significance during the patient’s lifetime. Accordingly, watchful waiting has been proposed as a reasonable option for DCIS,4 akin to what is currently offered for patients with early stage prostate cancer; however, how to implement such a strategy is unclear.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Doctor's treatment recommendation more powerful than names
Posted on August 27, 2013
Candace Andrews
Breast Cancer Club
Conflict of Interest: None Declared
I believe the results of this study validate the impression that presented with an incidence of abnormality using language that match the likelihood of progression and the urgency/non-urgency of invasive treatment, patients will more likely opt for the treatment deemed appropriate by the physician. However, on what basis will the physician recommend a non-surgical option for ductal in situ abnormalities? What research has been done involving active surveillance of DCIS? Is not the standard of care at this time surgery, generally followed by radiation and Tamoxifen? Before we worry about the language used to describe the abnormalities, there needs to be broad consensus among doctors as to the circumstances that would encourage a non-surgical or non-invasive treatment recommendation. Plainly put, I have never heard of a doctor recommending anything but biopsy when suspicious (clustered) calcifications are detected on imaging and surgery at minimum when DCIS is confirmed.
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