If a doctor tells you that you have cancer but it has not spread, is it still cancer? That's like asking the age-old question “If a tree falls in the woods and nobody is around to hear it, does it make noise when it falls?”
Ductal carcinoma in situ is a noninvasive form of breast cancer. According to published news reports, about 26% of US women diagnosed breast cancer have ductal carcinoma in situ. According to a Newsday report yesterday, the American Cancer Society estimated that for the year 2010, 54,000 new cases of noninvasive cancer of DCIS. will be detected. Separately, the American Cancer Society estimates that for this year, 207,000 cases of invasive breast cancer will be diagnosed.
Newsday raised a controversial issue. Should patients who are diagnosed with ductal carcinoma in situ be treated? The Newsday headline is “Cancer treatment a matter of debate.”
This takes me back to the first question I asked above, if someone tells you that you have cancer do you need treatment? The article points to semantics being played between the American College of Pathologists, and the American Council on Health and Science in Manhattan. In fact, Dr. Elizabeth Whelan, director is quoted by Newsday as saying “DCIS. is noninvasive and may lose its official status as 'cancer' in the future.” “DCIS its stage 0, which means it's noninvasive and may or may not become invasive,” Dr. Whelan stated. Other physicians quoted in the Newsday article confirmed that DCIS is cancer and not pre-cancer.
Importantly, this condition poses a risk to the breast and if undiagnosed and untreated can go on to ultimately become invasive.
Any time you see an article questioning whether treatment is necessary or required, look deeper to see if there is a hidden agenda by the researchers who performed those studies. Many times you will find that there is a cost factor involved where researchers are trying to inhibit the cost of healthcare by weighing the risks of patients needing further care compared to the risk of developing the full-blown disease.
Dr. Karen Kostroff, the chief of breast cancer surgery at North Shore-Long Island Jewish health system raises a very important point. She says that some forms of DCIS stay contained while others become invasive. Those researchers who believe that DCIS do not require treatment are unable to determine when those noninvasive cancers will turn into an invasive cancer.
The key goal with treating any type of cancer is the early detection, diagnosis and treatment.
1. "Carcinoma" is still cancer until the name gets changed for a good reason and with academic consensus. 2. Perhaps this is why "lumpectomy" has such good results. 3. Any female attorneys out there who would opt for "watchful waiting" with this diagnosis?
by Chuck Pilcher MD FACEP November 30, 2010 at 06:42 PM
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