Discrepancies and challenge of ductal carcinoma in situfor health professionals
© BioMed Central Ltd 2008
Published: 13 May 2008
Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer. While debate persists about its most appropriate treatment, women diagnosed with DCIS are faced with a paradox; although they are often reassured that the condition has been caught early and is not life-threatening, they undergo similar treatments (including mastectomy) to invasive breast cancer patients . Ongoing research by the authors exploring the psychosocial impact of DCIS has found that women hold diverse beliefs about the condition . This work, along with previous research, suggests that DCIS patients can be confused about the condition and that the terminology used by health professionals and the treatment recommendations given to patients may enhance this misunderstanding . Health professionals' attitudes about DCIS may also vary, which in turn could impact on patient care, satisfaction and risk perceptions of the condition. Previous research suggests that discrepancies between patient and health professional perceptions of invasive breast cancer can disrupt communication and compromise care . Therefore, the present study aimed to explore health professionals' perceptions of DCIS, including the terminology they use with patients and the challenges the condition presents in their work.
Two hundred and ninety-three UK health professionals (for example, surgeons, breast care nurses, radiologists, oncologists and radiographers) involved with the diagnosis and treatment of DCIS patients completed an online survey including demographic information and items relating to the terminology used to describe DCIS, risk and perceptions. A number of open-ended questions, providing qualitative data, were also included.
Findings suggest that professionals have diverse beliefs about DCIS; 35.2% perceived it as breast cancer, whereas 44% viewed it as a precancer. Oncologists were significantly more likely to view it as not breast cancer (χ2 = 14.83, df = 6, P = 0.022). Participants were asked to rate the risk associated with DCIS for patients' overall long-term health. The results suggest that breast care nurses, surgeons and oncologists considered it to be less serious than radiologists, radiographers and pathologists. Overall, however, 80% rated DCIS as a low (39.6%) or intermediate risk (41.3%), but despite this relatively positive prognosis 46.8% of health professionals found explaining DCIS to patients more difficult than invasive breast cancer. The qualitative findings indicate that explaining the condition and the lack of consistent terminology between health professionals was a key challenge.
The findings suggest that there is considerable variation in both health professionals' perceptions of DCIS and the terminology they use. This is likely to have a substantial impact on patients' experiences and perceptions, which is the focus of ongoing research by the authors. The nature and impact of these variations warrant further exploration and debate with both health professional and patient groups in order to inform the provision of appropriate care and information to meet the needs of DCIS patients.
Funded by a PhD studentship grant from Breast Cancer Campaign.
- Webb C, Koch T: Women's experiences of non-invasive breast cancer: literature review and study report. J Adv Nurs. 1997, 25: 514-525. 10.1046/j.1365-2648.1997.t01-1-1997025514.x.View ArticlePubMedGoogle Scholar
- Kennedy F, Harcourt D, Rumsey N: The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS). Eur J Oncol Nurs. 2007,Google Scholar
- De Morgan S, Redman S, White KJ, Cakir B, Boyages J: 'Well, have I got cancer or haven't I?' The psychosocial issues for women diagnosed with ductal carcinoma in situ. Health Expect. 2002, 5: 310-318. 10.1046/j.1369-6513.2002.00199.x.View ArticlePubMedPubMed CentralGoogle Scholar
- Buick DL: Illness representations and breast cancer: coping with radiation and chemotherapy. Perceptions of Health and Illness: Current Research and Applications. Edited by: Petrie KJ, Weinman JA. 1997, Amsterdam: Harwood Academic Publishers, 379-409.Google Scholar