A common diagnosis of very early-stage breast cancer sends thousands of women into the operating room each year for mastectomies or lumpectomies, but a new study now suggests that such surgeries may be unnecessary.
In an article published Thursday in JAMA Oncology, researchers at Toronto’s Women’s College Research Institute and the University of Toronto reported that those who opted for surgery as a result of a diagnosis of ductal carcinoma in situ (D.C.I.S.) were just as likely to die of breast cancer as women in the general population.
As Gina Kolata reports in the New York Times, the study has re-ignited debate over the efficacy of mammograms and the aggressive treatment typically recommended by doctors. “In medicine, we have a tendency to get too enthusiastic about a technique and overuse it,” Otis Brawley, MD, chief medical officer at the American Cancer Society, told Kolata. “This has happened with the treatment of D.C.I.S.”
Some 60,000 women each year are diagnosed with D.C.I.S., a number that has dramatically increased in recent years as radiologists have become increasingly adept at detecting ever-smaller lesions in mammograms. And doctors have long held the view that D.C.I.S. leads to often-fatal invasive cancers. But the new study does not support that view. Researchers, including lead study author Steven Narod, MD, followed 100,000 women who had received the diagnosis and opted for surgery. They found that, two decades later, their chance of dying of breast cancer was similar to women who had never been diagnosed — about 3.3 percent.
“I think the best way to treat D.C.I.S. is to do nothing,” said Narod.
Other treatment options might include hormonal or immunological therapies that would make the breast environment more resistant to cancer-cell growth, said Laura Esserman, MD, a University of California, San Francisco breast-cancer surgeon and researcher. “As we learn more, that gives us the courage to try something different,” Esserman said.
There are a variety of alternative and complimentary approaches to cancer treatment described in “Integrative Oncology: A Healthier Way to Fight Cancer” from our May 2013 issue. And for more on cancer-survival tactics, see “Living Strong With Cancer” in our November 2007 issue.