WASHINGTON —聽A has reignited the debate about treating a condition sometimes known as “Stage 0” breast cancer.
It’s called ductal carcinoma in situ, or DCIS, and it occurs when cancerous cells turn up in milk ducts in the breast. Two-thirds of the time, those cells don’t move, but in some聽cases, they have the potential to spread and turn deadly.
Currently, almost all women who get DCIS undergo treatment, usually in the form of a lumpectomy and radiation or a mastectomy, 聽because it is impossible to predict at the time of diagnosis whose聽cancer cells聽will break through protective membranes.
That led the Canadians, who crunched聽U.S. government data聽on more than 100,000 cases, to suggest some of these women were over-treated. Their report, published in the journal JAMA Oncology,聽says radiation after surgery did not increase their chances of survival.
A local breast cancer expert challenges that assertion on scientific and personal terms.
“There are two ways of looking at it,” says , director of the 聽and a breast cancer survivor.
She says it’s true that two-thirds of DCIS patients are over-treated, but she adds the only way to help the women who really need it is to treat them all.
“The whole controversy of聽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鈥檚 impossible to know who will benefit.
She says modern medicine has the opportunity here “to life-save, as imperfect as it may be.”
Research is underway to better understand which women with DCIS have cancer cells that are biologically predisposed to spread, and advances in genetics are giving the effort a boost.
Brem聽says the stakes are especially聽for younger women and African-American women. The Canadian study put the overall mortality rate 20 years after diagnosis at 3聽percent for women whose cancer was confined to a milk duct. It was twice as high for women under 35 and black women.
