Over 50,000 women a year get a call from their doctor giving them the best possible kind of bad news. The diagnosis of DCIS, also called Stage 0 breast cancer, has increased dramatically as mammography technology has improved and more women are screened. A mammogram can now pick up small calcium deposits called micro-calcifications which show up as a trail or cluster of white specks. As most DCIS is discovered along with these calcifications, the next step is a biopsy to confirm the presence of abnormal cells.
The good news is that DCIS is not invasive cancer. These atypical pre-cancerous type cells are all safely sitting inside the walls of the milk duct. But the fact that it has the word carcinoma in it does make it a scary diagnosis that sends many women into panic mode with fears of hair loss and life-threatening illness. This reaction causes some women to quickly opt for mastectomies, sometimes double mastectomies, which can have long-term painful side effects as well as affecting self-image and sexual response.
The conventional path for many years has been to treat DCIS very aggressively just as oncologists would early-stage invasive breast cancer. This means surgery, a lumpectomy, or mastectomy, followed by radiation treatments and in many cases 5 years of estrogen-blocking medication. The reason is that we just don’t know for sure which of these tiny clusters will become invasive cancer.
Because the appearance and pathology of the problem cells look like invasive cancer, the thinking has been that these are very early-stage cancers and removal and treatment is the answer. But long-term studies have shown that the removal of 60,000 DCIS lesions per year has not reduced the cases of invasive cancer. Compare that to the removal of polyps during a colonoscopy, which has greatly reduced the rates of colon cancer.
Many physicians have been expressing concern that women are being overly frightened, undergoing stressful biopsies and life-changing surgeries as a precaution, not a cure for an actual disease. Women should be encouraged not to act impulsively, but take the time to understand the full picture and all the options. UCSF breast cancer oncologist Shelley Hwang MD, is exploring the idea of using estrogen-blocking drugs alone as an alternative, also biological and genetic markers are being studied in an effort to determine which women are at lower risk and can avoid surgery and radiation.
Some precancerous cells are aggressive, but some DCIS could stay put until women are in their nineties. There are several studies underway to see if “active surveillance,” which is now used to watch prostate cancers, could be applied to DCIS. This requires the patient to be knowledgeable and willing to weigh the risks and benefits, and the physician to be willing to break with convention to possibly improve quality of life and outcomes.
So, if you or someone you love is diagnosed with DCIS, stop and take a long, deep breath and remember – this is not an emergency. Take the time to do your research. A good place to start is Dr. Susan Love’s website
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