The data showed that some patients were at higher risk: those younger than 40, black women, and those whose abnormal cells had molecular markers found in advanced cancers with poorer prognoses.
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But a massive new study has the medical community rethinking its approach to treatment, and has led to questions about whether thousands of women are undergoing unnecessary surgery and radiation treatment.
The 20-year mortality rate for breast cancer among women in the study was 3.3 percent. Treatments for DCIS can range from mastectomy or even bilateral mastectomy to lumpectomy, with or without radiation.
“Given the low breast cancer mortality risk, we should stop telling women that DCIS is an emergency and that they should schedule definitive surgery within 2 weeks of diagnosis”, writes Laura Esserman of the University of California, San Francisco in an editorial accompanying the study.
The majority of women with DCIS (54.1 per cent) who died of breast cancer did not have an invasive in-breast recurrence of cancer, prior to death. The cancer risk increased with just one glass per day.
Studies have found that even as almost 60,000 women undergo surgical treatment each year for these Stage 0 cancers that are thought to be a precursor to the full-blown disease, the number of invasive breast cancers – the ones that kill – has not decreased. Only that would conclusively show whether most women with DCIS are being over treated. “In these cases, we’ve found that there’s an inherent potential for DCIS to spread to other organs”.
“The whole controversy of over-diagnoses is that we treat all women with DCIS because we have the opportunity to save the life of a third of them”, Brem says, adding that it’s impossible to know who will benefit. These treatment recommendations stem from studies that looked at how many woman had a recurrence of DCIS or breast cancer and required additional treatment. It is therefore appropriate to consider these as de facto breast cancers and not as preinvasive markers predictive of a subsequent invasive cancer.
“Treatment comes with short- and long-term impacts”, Jaggar said, noting that women who get cancer treatment are less likely to be employed several years later and tend to earn less than before.
The researchers used data from two different studies in the United States, which tracked down the health of over 88,084 women and 47,881 men, and the tracking was done for up to 30 years. The director of the Familial Breast Cancer Research Unit at Women’s College Research Institute, in Toronto goes on to say, “Clinically, the fact is that 3 percent in the big picture should be reassuring”.
The researchers defined light to moderate drinking as up to 15g of alcohol per day for women and up to 30g alcohol a day for men, the worldwide Business Times noted. And while they’re learning more, they’re erring on the side of caution. Treatment could also vary for premenopausal women and post menopausal women.
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He said the new study tells doctors more work should be done to assess the risk of DCIS for women. Some had developed invasive disease in either breast, but more than 500 deaths were in women never diagnosed with a second tumor or recurrence, meaning their DCIS had likely spread before they received treatment, Narod said.
