Treatment Of Breast Cancer Stage 0 — Proactive Or Unnecessary?

Breast Cancer is a scary and dangerous disease, and it’s not particular about who it inhabits. In a field where early detection and aggressive treatment is thought to be the difference between life and death, a DCIS (also known as ductal carcinoma in situ) diagnosis can be seen as a miracle. DCIS is sometimes referred to as breast cancer stage 0. If we think about it, doesn’t diagnosing someone as having reached stage 0 in anything mean that they, in fact, haven’t yet received the illness/disease? Yet in the breast cancer world, this stage is something that is treated, sometimes going as far as performing a mastectomy, and at other times a lumpectomy.

According to CNN, and the American Cancer Society, more than 60,000 cases of DCIS are diagnosed annually. At first glance, you have the urge to stand up and give a round of applause for early detection. However, The New York Times describes DCIS as “tiny clusters of abnormal breast cells, confined to a milk duct and too small to be felt.” The fact that there is a lump does not mean that there is cancer involved, and it doesn’t mean that it will eventually become breast cancer. It could remain a lump filled with nothing but tissue (or some other equally non-life threatening thing). On the other hand, it could turn into something a little more serious. You must see the debate as to why doctors are divided on how to treat breast cancer stage 0 or whether or not to treat it at all.

On August 20, the Journal of American Medical Association of Oncology (here on out referred to as JAMA Oncology) put out a new analysis on breast cancer research, specifically targeting and focusing on cases of DCIS. Their findings, while adding some new information, didn’t exactly clear things up. NBC News has reported the findings in layman’s terms stating that 3 percent of women that were diagnosed with this potential breast cancer, DCIS, seemed to have died from breast cancer whether or not they were treated for it. That is a low percentage, but to have the results be the same regardless of treatments rather raises more questions than answers them. What the analysis did find was that, much like any cancer, there are certain aspects of a person’s life and biology that make them more susceptible to it. Things like age, race, living conditions –I all of those things played a role and will continue to.

Some can, and do, hold this new analysis as support for the treatment of DCIS. That is due in large part to the lower rate of recurrence present with the treatment of this so called breast cancer stage 0. Others refute that by questioning whether or not there would have been any recurrence in the first place. Because the treatment was performed so early, there are too many what-ifs to say if it’s actually necessary. Are doctor’s being too aggressive with the possible cancer? It has happened over the course of history that a disease is treated hard only to find a gentler course later on. The adverse is true too.

Women who find lumps or who have been given a breast cancer diagnosis, even a stage 0, don’t want to take any chances. Of course this is a generalization, but true. Having it treated immediately and with options is something that can greatly alleviate their concerns, and maybe that is something in favor of treating DCIS. Shannon Doherty is now lamenting early detection, and maybe it would have made a difference in her case. The mental aspect of detection and treatment is certainly something that should be a part of these studies, and it is something that plays a very large role in a patient’s outcome.

Dr. Otis Brawley, chief medical officer of the American Cancer Society had a great point when he talked with CNN. He said, “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.”

Get your mammograms. Get informed, and don’t jump without looking. Know your diagnosis and only make informed decisions. It’ll be different for everyone, and maybe that’s more the point.

[Image via Michael Kovac/Stringer]