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Treating DCIS

Posted 11/26/2013

Posted in

  DCIS is suddenly very much in the news. As you likely know, DCIS is ductal carcinoma in situ, sometimes called a pre-cancer or Stage 0. LCIS is less common, but the same thing in the lobes: lobal carcinoma in situ. In either case, the cells are abnormal, but are not yet malignant--and therein lines the complexity. Not all DCIS/LCIS cells will ever become cancer, but we don't yet know how to differentiate those that will from those that won't. This means that everyone gets treated.

  There has been a lot of public discussion recently about changing the names. Including "cancer" as part of the name is surely more frightening than some other term would be. Most of us hear "cancer" and panic.

  Until about ten or twelve years ago, DCIS was routinely treated with mastectomy. Women then were really baffled why they, in the absence of a "real" cancer diagnosis, needed a mastectomy while many women with invasive cancer were treated with a wide excision and radiation. That has evolved and changed, so the usual standard of care is lesser surgery for both groups. Of question and debate and clinical trial now is whether some/all DCIS should be treated at all.

  This is a beautifully written and very interesting article from Cancer World. It is well worth your time.

Going public on DCIS
Ending the overtreatment of women with DCIS will require enough women to have the courage and insight to demand something better. Tiffany O’Callaghan won a Best Cancer Reporter Award for opening up the debate with her article in the New Scientist, which is republished here

by Tiffany O'Callaghan

The lump in her right breast was smaller than a pea. When she first noticed it, last August, 28-year-old photographer Ellen Doherty was busy working on an exhibition. She put off visiting the doctor for a month. 

When Doherty finally went, the doctor said it was probably nothing to worry about. But they did a scan to be sure – and that led to several more tests. Finally they said she had a 2.8-millimetre tumour known as ductal carcinoma in situ, or DCIS. 

Like many women given this diagnosis, Doherty had never heard of it before. She quickly devoured any information she could find, but came away confused. 

The term “in situ” means that the cancerous cells are contained within the breast’s milk ducts and have not invaded the surrounding tissue. This kind of lesion is not harmful unless it progresses past that stage and becomes invasive, but it is treated just as aggressively as invasive cancer. Yet this approach is increasingly being questioned, as evidence emerges that for some women DCIS would not turn out to be dangerous. 

In fact, DCIS could be regarded as a creation of modern medicine, as most cases are found through breast screening – 30 years ago it was rarely diagnosed. The fear is that screening may be leading us to cut out lumps that, left alone, would have never caused a problem. “Are we helping people by diagnosing it, or are we making things worse?” asks Beth Virnig, who monitors cancer surveillance and detection data at the University of Minnesota in Minneapolis. Breast cancer used to be discovered only if it formed a noticeable lump or caused other symptoms such as nipple discharge. Since the advent of breast screening programmes using X-rays known as mammograms in the 1980s, it is more commonly found that way. And that means growing numbers of DCIS cases are being detected. In the US, the incidence has grown more than eight-fold since the 1980s. DCIS now makes up about a quarter of breast cancer cases found through screening.


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