A simple change in wording—from “cancer” to “lesion”—can shift the way people view papillary thyroid cancer (PTC), according to a new study in JAMA Otolaryngology-Head & Neck Surgery. This finding could help inform how experts refer to low-risk conditions such as PTC that are currently labelled as “cancer.”

“Screening and autopsy studies indicate that asymptomatic PTCs are present in more than 10% of the adult population, and with the surge in the use of diagnostic ultrasound, other imaging modalities, and fine-needle aspiration, these cancers are now more frequently identified,” wrote authors, led by Brooke Nickel, BSc, MIPH, The University of Sydney, Wiser Healthcare, Sydney, Australia. “As a result of this, overdiagnosis and subsequent unnecessary treatment has now been recognized to occur in patients with PTC.”

Currently, patient preferences with regard to either active surveillance or surgery for PTC are unknown, because clinicians tend to promote surgical options. Shared decision-making between patients and physicians can be improved by understanding such preferences for PTC treatment, as well as the role terminology plays.

Two previous experiments have indicated that refraining from referring to ductal carcinoma in situ (DCIS) as “cancer” resulted in higher preferences for nonsurgical treatment options. Like PTC, DCIS is a low-risk condition.

In the current study, researchers examined treatment preferences for PTC using a discrete choice experiment (DCE), a quantitative technique premised on the notion that a health care service or intervention can be framed in terms of its attributes.

“Discrete choice experiments determine which attributes are driving preferences and the trade-offs between attributes that people are willing to accept,” the authors wrote.

In this study, 2,054 participants (48.3% men; average age=46 years) with no history of thyroid cancer completed a web-based survey in which they were randomized to receive 1 of 2 frames of information presented using either “cancer” or “lesion.” Researchers had the participants choose between thyroidectomy, hemithyroidectomy, or active surveillance, and analyzed results using a mixed logit model.

Overall, the participants were more amenable to the potential harms of treatment when they were framed using the word “cancer,” and not “lesion.”

“These findings are congruent with previous literature that demonstrates that the use of the cancer term may elicit higher patient preferences for more invasive treatment options,” the investigators wrote.

When weighing benefits and harms, participants were more willing to endure fatigue than they were other harms. The researchers posited that this may be because it is hard for most people to imagine troublesome fatigue. One limitation of this study is that the participants came from the general population and were not necessarily diagnosed with PTC.

“Health literacy plays an important role in treatment preferences, which may contribute to health inequalities,” the investigators concluded. “Changing the terminology of papillary thyroid cancer may be one strategy to help reduce overall preferences for more invasive treatment options and patient willingness to endure more serious unnecessary adverse effects from treatments.”

This story is contributed by Naveed Saleh and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.