I’ve written in a previous post about my experience of being diagnosed with breast cancer 18 years ago. I’ve always wondered if I should have forgone a mastectomy and adopted a watch and wait stance. However, when my doctors never gave me that option and my family was aghast at my doing anything less than full warfare on the invading cells in my body, I gave in to surgery.
The type of cancer I had, ductal carcinoma in situ or DCIS, is still under investigation. Is it or isn’t it cancer? If it doesn’t leak out of the lining of the milk glands and metastasize, is it truly deadly? The treatments given to women can sometimes cause more problems than living with cells that, in some instances, resolve. So I was happy to see more attention given to finding answers in a new study about DCIS in the JAMA Oncology (online) August 20, 2015.
I had become an advocate of taking “cancer” out of DCIS label. That way women wouldn’t panic and rush to having mastectomies and in some cases prophylactic double mastectomies. Hopefully “watch and wait” would be an added choice rather than have women succumb to unnecessary treatment.
After I read the original article in JAMA—I am not going to tell you I understood all the statistics—I realized that DCIS is what most cancers are: complicated. Some types of DCIS can predict that a lethal breast cancer can occur in the future. I am more sympathetic of the tightrope that physicians and surgeons walk in counseling their patients.
The accompanying editorial by Laura Esserman in the same JAMA issue gives the following suggestions:
Much of DCIS should be considered a “risk factor” for invasive breast cancer and an opportunity for targeted prevention.
Radiation therapy should not be routinely offered after lumpectomy for DCIS lesions that are not high risk because it does not affect mortality.
Low-and intermediate-grade DCIS does not affect mortality.
We should continue to better understand the biological characteristics of the highest-risk DCIS (large, high grade, hormone receptor negative, HER2 positive, especially in very young and African American women) and test targeted approaches to reduce death from breast cancer.
Hopefully these suggestions will become a common practice in health care settings so women like me won’t be regretting a choice they made based on incomplete knowledge and overdiagnosis by the medical professionals.
Good. Keep on educating the public. The phrase DCIS itself may scare people into unnecessary action.
Ironically a friend of ours just wrote last night that she has this very same diagnosis. I sent her your post because she is a biologist and works with data analysis all the tim.
So….thanks for writing this.
Yours is an interesting article on your own experience and paired with the current JAMA comments on DCIS.
In any situation we make the best decision we can on the evidence-based information available at the time. No added benefit of a crystal ball.
Yes, a crystal ball would be nice. However, now that there are new facts about DCIS I am hoping the medical establishment shares this with patients without claiming all DCIS warrants immediate intervention, i.e. mastectomy, radiation.