How different terminology for ductal carcinoma in situ impacts women's concern and treatment preferences: a randomised comparison within a national community survey.
How different terminology for ductal carcinoma in situ impacts women's concern and treatment preferences: a randomised comparison within a national community survey.
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导管癌的原位术语如何影响妇女的关注和治疗偏好：国家社区调查中的随机比较。
DOI：
10.1136/bmjopen-2015-008094
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发表时间：
2015-11-02
期刊：
影响因子：
2.9
通讯作者：
Barratt A
中科院分区：
文献类型：
--
作者：
McCaffery K;Nickel B;Moynihan R;Hersch J;Teixeira-Pinto A;Irwig L;Barratt A
有人呼吁将“癌”从原位癌（如导管原位癌（DCIS））的术语中删除，以减少过度诊断和过度治疗。我们研究了将DCIS描述为“异常细胞”与“浸润前乳腺癌细胞”对女性关注和治疗偏好的影响。社区样本的澳大利亚妇女（n=269）谁讲英语作为他们的主要语言在家里。在社区调查中进行随机比较。女性考虑一种假设情况，涉及DCIS的诊断描述为“异常细胞”（A组）或“浸润前乳腺癌细胞”（B组）。在每组中，最初的描述之后是替代术语和重新评估的结局。两组的妇女都表示高度关注，但仍表示最初强烈倾向于观察等待（64%）。试验组之间在最初的关注或偏好方面没有差异。然而，与接受相反顺序术语的组B中的女性相比，组A（“异常细胞”第一术语）中更多的女性表示，如果给予替代术语（“浸润前乳腺癌细胞”），她们会感到更担心（67%的组A vs 52%的组B会感到更担心，p=0.001）。与B组相比，当术语从“异常细胞”转换为“浸润前乳腺癌细胞”时，A组中更多的女性也改变了对治疗的偏好。在A组中，18%的女性改变了对治疗的偏好，而只有6%的女性改为观察等待（p=0.008）。相反，当术语转换时，B组的治疗偏好没有显著变化（9% vs 8%改变了其声明的偏好）。在一个假设的情况下，观察等待DCIS的兴趣很高，不断变化的术语影响妇女的关注和治疗偏好。从DCIS中删除癌症术语可能有助于减少过度治疗。
There have been calls to remove ‘carcinoma’ from terminology for in situ cancers such as ductal carcinoma in situ (DCIS), to reduce overdiagnosis and overtreatment. We investigated the effect of describing DCIS as ‘abnormal cells’ versus ‘pre-invasive breast cancer cells’ on women's concern and treatment preferences. Community sample of Australian women (n=269) who spoke English as their main language at home. Randomised comparison within a community survey. Women considered a hypothetical scenario involving a diagnosis of DCIS described as either ‘abnormal cells’ (arm A) or ‘pre-invasive breast cancer cells’ (arm B). Within each arm, the initial description was followed by the alternative term and outcomes reassessed. Women in both arms indicated high concern, but still indicated strong initial preferences for watchful waiting (64%). There were no differences in initial concern or preferences by trial arm. However, more women in arm A (‘abnormal cells’ first term) indicated they would feel more concerned if given the alternative term (‘pre-invasive breast cancer cells’) compared to women in arm B who received the terms in the opposite order (67% arm A vs 52% arm B would feel more concerned, p=0.001). More women in arm A also changed their preference towards treatment when the terminology was switched from ‘abnormal cells’ to ‘pre-invasive breast cancer cells’ compared to arm B. In arm A, 18% of women changed their preference to treatment while only 6% changed to watchful waiting (p=0.008). In contrast, there were no significant changes in treatment preference in arm B when the terminology was switched (9% vs 8% changed their stated preference). In a hypothetical scenario, interest in watchful waiting for DCIS was high, and changing terminology impacted women's concern and treatment preferences. Removal of the cancer term from DCIS may assist in efforts towards reducing overtreatment.