Labels, Language, and Other Strategies to Improve Communication About Lower Grade Ductal Carcinoma in Situ: Theoretical Review

Ductal carcinoma in situ (DCIS) is when abnormal cells are found in the milk ducts of the breast, but they have not spread outside the ducts. It is not an invasive cancer, but it can sometimes turn into cancer over time if not treated. Women with low or intermediate grade DCIS are counseled to undergo standards of care, which may include surgery, radiation, and/or endocrine therapy even though DCIS may not develop into breast cancer, prompting confusion and long-lasting anxiety. The purpose of this study was to identify ideal labels, language, and other strategies to improve communication about DCIS. We conducted a theoretical review of 12 studies published between 2011 and 2022 and analyzed our findings with communication accommodation theory (CAT). Women and clinicians differed in initial orientation and psychological accommodation. Women were confused and anxious because clinicians employed labels such as pre-cancer or stage 0 cancer, but referred to it as "only" DCIS. Women preferred that clinicians refer to "abnormal cells" and distinguish DCIS from invasive breast cancer. In contrast, clinicians incorrectly believed that women understood that pre-cancer or stage 0 cancer distinguished DCIS from invasive breast cancer, and rather than explaining, referred women to other sources of information. However, women and clinicians agreed on several ways to improve communication: approximation (e.g. plain language), interpretability (e.g. visual aids), interpersonal control (e.g. take time to answer questions), discourse management (e.g. discuss risk of spread/recurrence) and emotional expression (e.g. address concerns).