Are we too aggressive in treating certain types of breast cancer?

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BreastCancer

Did you know that more than 60% of all women over 40 in the United States have had a mammogram in the past two years. Of those women, 20% of mammograms detected something called ductal carcinoma in situ, or DCIS (Stage 0 breast cancer).  According to the American Cancer Society, more than 60,000 cases of DCIS are diagnosed every year. But it doesn’t mean breast cancer.

What is DCIS

DCIS are abnormal cells found inside the milk ducts of the breast. They can look like invasive breast cancer cells, but they haven’t spread into the breast tissue.  Doctors treat DCIS one of three ways: with a lumpectomy, removing the masses themselves; lumpectomy and radiation; or removing the breast altogether with a mastectomy.

Are we overtreating?

However, a new study published recently in Journal of American Medical Association Oncology questions the necessity of some of these treatments. Monitoring more than 100,000 women diagnosed with DCIS for 20 years, Dr. Steven Narod, of the Women’s College Research Institute in Toronto, and his colleagues found that women treated for DCIS had a similar chance of dying from breast cancer as those who had never been diagnosed. All the women were part of the National Cancer Institute’s SEER program, a database of cancer patients in the United States.

Not only did women who were treated have similar chances of dying from breast cancer as those who hadn’t been treated, but also the type of treatment didn’t seem to make much a difference.

Is there a benefit of treatment

Narod also pointed out that treatment provides more than just physiological benefit, but also psychological relief. In his analysis, women who were treated with lumpectomy and radiation reduced their risk of recurrence from 4.9% to 2.5%. Those who underwent a mastectomy further reduced their chance of recurrence to 1.3%. “The chances diminish by half with radiation, and are almost eliminated with mastectomy. People want to avoid it. Quality of life seems to be improved if recurrence was removed,” said Narod.”If you’re going to have this treatment to reduce recurrence, I would say get the mastectomy. The better of those two treatments, mastectomy involves a tremendous amount of mental relief.”

Dr. Otis Brawley, chief medical officer of the American Cancer Society, advised caution. “Take a deep breath and slow down. Learn about DCIS treatment. Talk to several doctors and interview them about treatment. But one does not need to run in and have both breasts removed just because [of] DCIS.”

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