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Is Early Stage Breast Cancer (DCIS) Treatment Too Aggressive?
September 18, 2015
It’s the sentence straight out of every woman’s nightmare: “You have breast cancer.”
In 2015, more than 60,000 women will hear those words and be diagnosed with ductal carcinoma in situ (DCIS), or stage 0 breast cancer.
For most, the recommended course of action will be a lumpectomy, where a cancerous lump is removed — some will undergo radiation as well. Others have a mastectomy, where the entire breast is removed — or a double mastectomy, where both the breast with cancerous tissue and the healthy breast are removed.
But a recent, exhaustive study published in the prestigious Journal of American Medical Association is casting doubt on whether aggressive treatment really makes a difference.
What Exactly Is DCIS?
Stage 0 DCIS is non-invasive. There’s no evidence that either cancer cells or non-cancerous abnormal cells have broken out of the area of the breast in which they began, or that they’ve invaded nearby normal tissue.
DCIS accounts for one out of every five breast cancer cases in the U.S. — the rate of diagnosis shot up after mammograms became more common around 1980, even though the United States Preventive Services Task Force didn’t recommend them and even went so far as to show that mammograms can cause cancer.
Currently, it is thought to be a precursor for invasive breast cancer, where cancer cells do begin either breaking through to or invading normal breast tissue. But for some women, DCIS never spreads and turns into an invasive cancer, meaning treating it is ultimately unnecessary.
What Does This New Study Say?
A recent study published in the journal JAMA Oncology, which tracked 100,000 women for 20 years, found that treating this early stage of breast cancer aggressively, with treatments other than lumpectomies, had no effect on whether a woman would be alive a decade later.
According to the study, women with DCIS had nearly the same chance of dying from breast cancer (about 3.3 percent) as women outside the study. For those who did die, it happened despite being treated, not because of a lack of treatment.
The study raises a myriad of questions for patients and their doctors. DCIS is normally treated as an early cancer that will spread in the breast if left untreated. But if that was the case, the women who opted to have mastectomies should have been less likely to later develop invasive cancer.
Following this logic, as mentioned in an editorial that accompanied the study, as more women with DCIS were treated, the rate of new invasive cancers should have dropped — but this wasn’t the case. This raises the question if treatment should even be given to those women who receive a stage 0 breast cancer diagnosis or if close monitoring is enough.
What Are the Study’s Limitations?
The study does have its limitations, however. While it followed a large sample of women, it didn’t compare treatments separately, but rather looked at national cancer data that was collected over the two decades.
For many doctors, the ideal study would instead randomly assign women to receive a lumpectomy, a mastectomy or no treatment at all, and prove that aggressive treatment is unnecessary for most patients.
If the latter proved to be true, doctors could begin to treat DCIS as a risk factor for invasive breast cancer. Changes in diet, exercise, and adding hormonal or immunotherapy treatments could make a woman’s body less desirable for invasive breast cancer cells to form and spread in.
The study also pointed out that women under 35 who are diagnosed with DCIS and African-American women are at a higher risk of developing invasive breast cancer in their lives. For these subsets, aggressive treatments could, in fact, save their lives.
But probably the No. 1 unanswered question that stems from this and most other cancer studies is that research isn’t advanced enough yet for doctors to know which cases of DCIS will progress and which will not.
‘I Have DCIS. Now What?’
If you’ve been diagnosed with DCIS, you might want to get a second opinion. Because pathology reports are subjective, you want to make sure, as much as is possible, that a doctor hasn’t missed any areas of invasive cancer.
It’s also important to find a doctor who will listen to your concerns and answer your questions. Most doctors will advocate for some type treatment, but together, you and your doctor can choose the course of action that’s best for your body, including close monitoring, hormonal therapies and adding natural cancer treatments.
Knowing your family history, including your father’s, is also essential. Women with a history of breast or ovarian cancers on either side of the family might want to pursue a more aggressive treatment than those without.
Ultimately, science is still working on the answers to some of our most pressing health problems. But by arming yourself with as much information as possible, you can make the best decision out of the available options.
Meanwhile, I encourage you to continue to seek natural, preventative treatments for all-too-common cancers like breast cancer. Only recently, another major study came out that declared the Mediterranean diet, especially one high in extra-virgin olive oil, reduces the risk of breast cancer.
