According to the American Cancer Society nearly 60,000 women a year are told they have the earliest form of breast cancer, called ductal carcinoma in situ, or DCIS. Around 25 percent of breast cancers are DCIS.
A new study argues that this non-invasive form of the disease is being over-diagnosed and over-treated. This is an argument that has been made by many experts over the last few years.
“The research in JAMA Oncology looked at more than 100,000 women with DCIS and found aggressive treatments do not reduce breast cancer mortality rates,” according to CBS news.
Many patients are opting not to dive into surgery or chemotherapy based on this information.
Ms. Mann, who was diagnosed with DCIS after a routine mammogram three years ago (now 52 years old), said her initial reaction was, ‘get this out of my system’.
But Ms. Mann’s doctor, breast cancer surgeon Dr. Esserman at the University of California, San Francisco, is considered a pioneer of ‘active surveillance’ or ‘watchful waiting treatment for breast cancer. Based on her research she suggested that instead of heading into surgery for a biopsy, lumpectomy, or mastectomy, Esserman monitors some patients who have been diagnosed with low-grade DCIS with extra screening and medication for a period of six months.
Dr. Esserman said, “Part of the personalization of medicine and breast cancer is not just to do more for those who need it but to do less for those that don't. If DCIS shows little or no growth, patients can avoid more aggressive treatment.”
This approach has worked for her patients so far. Dr. Esserman is the director of the Carol Franc Buck Breast Care Center.
Dr. Esserman believes that when time is not of the essence it’s important to offer the patient different options and wait and see how the tumor behaves.
The American Cancer Society estimates that around 40,000 women in the U.S. die of breast cancer each year. Studies show that around one-third or more of DCIS cases will progress to invasive cancer if not treated.
The difficult part is figuring out which cases of DCIS are most likely to worsen. That uncertainty causes some women to aim for more aggressive treatment plans.
CBS talks about some DCIS cases where the patient does opt for aggressive treatment. For example, Kristin’s mother died from breast cancer so when the 42-year-old was told she has DCIS she decided to get a double mastectomy.
Kristin said, “I don't have to go in for the every six months active surveillance, and have the worry and the anxiety and the stress of, 'Am I going to end up like my mom?”
Dr. Esserman’s approach is controversial but she hopes it will catch on and says that it is in the best interest of patients to know their options.