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| Study: common form of breast cancer may warrant less aggressive treatment | Study: common form of breast cancer may warrant less aggressive treatment |
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| Women who are treated for what has come to be considered a non-invasive breast cancer of the milk duct could need less treatment – not more – a new study of more than 100,000 women indicates. | Women who are treated for what has come to be considered a non-invasive breast cancer of the milk duct could need less treatment – not more – a new study of more than 100,000 women indicates. |
| The study, which appears in the Journal of the American Medical Association (JAMA) Oncology this week, found that women treated for ductal carcinoma in situ, a group of abnormal cells found in the milk duct, were not significantly less likely to die of breast cancer than women on average. Some patients who received radiation therapy actually fared worse, especially if the treatment was on the left side. | The study, which appears in the Journal of the American Medical Association (JAMA) Oncology this week, found that women treated for ductal carcinoma in situ, a group of abnormal cells found in the milk duct, were not significantly less likely to die of breast cancer than women on average. Some patients who received radiation therapy actually fared worse, especially if the treatment was on the left side. |
| “What this study tells us is that our treatment of DCIS is so good that rarely does anyone who ever has DCIS die from it, or indeed their death rate is the exact same as people who don’t have DCIS,” said Dr Otis Brawley, chief medical officer at the American Cancer Society. “Either we’re incredibly good at treating this disease, or we’re treating a disease that frequently doesn’t need to be treated.” | “What this study tells us is that our treatment of DCIS is so good that rarely does anyone who ever has DCIS die from it, or indeed their death rate is the exact same as people who don’t have DCIS,” said Dr Otis Brawley, chief medical officer at the American Cancer Society. “Either we’re incredibly good at treating this disease, or we’re treating a disease that frequently doesn’t need to be treated.” |
| Related: Daily glass of wine raises risk of breast cancer in women | Related: Daily glass of wine raises risk of breast cancer in women |
| Perhaps most significant for women diagnosed with DCIS, the difference in survival between mastectomies and lumpectomies was not significant – meaning life-altering double mastectomies were no more effective than small lumpectomies in terms of survival. | Perhaps most significant for women diagnosed with DCIS, the difference in survival between mastectomies and lumpectomies was not significant – meaning life-altering double mastectomies were no more effective than small lumpectomies in terms of survival. |
| DCIS accounts for up to 25% of mammography-detected breast cancer diagnoses. Celebrity chef Sandra Lee is perhaps the best known women to recently come forward with a diagnosis. | DCIS accounts for up to 25% of mammography-detected breast cancer diagnoses. Celebrity chef Sandra Lee is perhaps the best known women to recently come forward with a diagnosis. |
| While the study and an accompanying editorial suggest clinicians use less treatment, it also raises the possibility that DCIS has more in common with invasive cancers than previously thought. Researchers said it’s not clear to what extent a breast cancer diagnosis after DCIS is a consequence of a recurrence, or whether DCIS has a high potential to be malignant from the outset. | While the study and an accompanying editorial suggest clinicians use less treatment, it also raises the possibility that DCIS has more in common with invasive cancers than previously thought. Researchers said it’s not clear to what extent a breast cancer diagnosis after DCIS is a consequence of a recurrence, or whether DCIS has a high potential to be malignant from the outset. |
| The findings are likely to intensify debate – and study – of DCIS. In the last 10 years, physicians have called to remove the word carcinoma (cancer) from the disease’s name, even as intensified efforts to detect cancer early have increased a focus on calcium deposits in the breasts, where such “pre-cancerous” cells are often found. Before screening was widespread, DCIS accounted for just 3% of all breast cancer diagnoses. | The findings are likely to intensify debate – and study – of DCIS. In the last 10 years, physicians have called to remove the word carcinoma (cancer) from the disease’s name, even as intensified efforts to detect cancer early have increased a focus on calcium deposits in the breasts, where such “pre-cancerous” cells are often found. Before screening was widespread, DCIS accounted for just 3% of all breast cancer diagnoses. |
| The study analyzed information from 18 large databases, spanning from rural Georgia to Los Angeles to Alaska. The databases, known as the surveillance, epidemiology and end results databases, or SEER, track outcomes and treatments without using patient’s identities, and cover roughly 28% of the American population. | |
| Related: Cancer survival rates three times higher with early diagnosis | Related: Cancer survival rates three times higher with early diagnosis |
| Researchers isolated more than 100,000 women who had been diagnosed with DCIS, also known as stage zero breast cancer, and compared their 10- and 20-year mortality rates against women from the general population had died of breast cancer. | Researchers isolated more than 100,000 women who had been diagnosed with DCIS, also known as stage zero breast cancer, and compared their 10- and 20-year mortality rates against women from the general population had died of breast cancer. |
| Researchers found that for all but a minority of young women diagnosed with DCIS, those treated aggressively with mastectomies or lumpectomies in combination with radiation were no less likely than women on average to die of breast cancer after 20 years. Medical experts take this as an effective rate that is so high, it calls into question whether treatment is impacting outcomes. | Researchers found that for all but a minority of young women diagnosed with DCIS, those treated aggressively with mastectomies or lumpectomies in combination with radiation were no less likely than women on average to die of breast cancer after 20 years. Medical experts take this as an effective rate that is so high, it calls into question whether treatment is impacting outcomes. |
| “We’re not suggesting a do-nothing, wait-and-see approach. We’re suggesting that the basic treatment – the basic treatment would be to just remove the [cells through a] lumpectomy,” said Dr Steven A Narod, the lead researcher on the study. Researchers were based at the Women’s College Hospital in Toronto and Toronto University. | |
| Researchers reported several seemingly contradictory findings. Narod’s team concluded that DCIS has more in common with invasive breast cancers than previously thought, because localized treatments such as lumpectomies, mastectomies and radiation therapy don’t appear to have a significant impact on mortality. | |
| Because of that, researchers concluded that for all but high risk patients treatment less aggressive treatments should be considered by clinicians, such as lumpectomies alone. | Because of that, researchers concluded that for all but high risk patients treatment less aggressive treatments should be considered by clinicians, such as lumpectomies alone. |
| High-risk patients were identified as those diagnosed younger than 40 (which researchers suggested could constitute a different disease), black women and those whose DCIS tests positive for HER2, a protein which can increase the growth of cancerous cells. | |
| “You shouldn’t feel like you have a ticking time-bomb in your breast and your life is over,” said Brawley. “You really feel for the large number of women who are diagnosed with DCIS who really are concerned that they have breast cancer, and that name is so intimidating. It really does make it sound like it’s something of far greater risk than it actually is.” | “You shouldn’t feel like you have a ticking time-bomb in your breast and your life is over,” said Brawley. “You really feel for the large number of women who are diagnosed with DCIS who really are concerned that they have breast cancer, and that name is so intimidating. It really does make it sound like it’s something of far greater risk than it actually is.” |