Well, the medical community has finally admitted it
August 20, 2015 11:16 AM Subscribe
According to the New York Times today, reporting on new research on Ductal Carcinoma in Situ (DCIS) "it now appears that treatment may make no difference in their outcomes. Patients with this condition had close to the same likelihood of dying of breast cancer as women in the general population, and the few who died did so despite treatment, not for lack of it, researchers reported Thursday in JAMA Oncology." (Previously, in which you'll find my own personal rant about mammography)
Listen, I don't want to say I told you so or anything but merely thinking about this issue has been enough to raise my blood pressure ever since I had breast cancer in 2009. That experience has shown me that it is absolutely criminal to tell any woman that she has breast cancer when there was no evidence that DCIS would ever develop into cancer. Calling it "pre-cancer" or "Stage 0 cancer" doesn't prevent women from going through absolute hell: disrupting their emotional lives, their work, their relationships, their feelings about their bodies, causing them to go through painful, disfiguring treatment with many negative side effects, and giving them a fear that never really goes away.
From the NY Times article:
Diagnoses of D.C.I.S., involving abnormal cells confined to the milk ducts of the breast, have soared in recent decades. They now account for as much as a quarter of cancer diagnoses made with mammography, as radiologists find smaller and smaller lesions. But the new data on outcomes raises provocative questions: Is D.C.I.S. cancer, a precursor to the disease or just a risk factor for some women? Is there any reason for most patients with the diagnosis to receive brutal therapies? If treatment does not make a difference, should women even be told they have the condition?
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This is the first I've heard of a serious research project around DCIS. Last I checked, the state of the research was that no study had been performed on woman diagnosed with DCIS who had declined treatment and that autopsies performed on women (for other reasons and not in any systematic way to research DCIS) seemed to indicate that about 15 percent of women died *with* DCIS, but not *of* DCIS.
From The National Center for Biotechnology Information:
At 10 years following DCIS diagnosis, overall breast cancer mortality consistently is less than 2 percent.295–297 In official publications, the SEER registries report 0 percent breast cancer mortality after 5 years, reflecting the belief that there is no mortality from DCIS unless there is an invasive recurrence or new invasive primary tumor, in which case the mortality would be attributed to the recurrence or new tumor.4 Ernster5 estimates 0.7 percent breast cancer mortality within 5 years and 1.9 percent within 10 years for women diagnosed between 1984 and 1989. Ernster also reports that breast cancer mortality declined significantly between 1978–1983 and 1984–1989 (10 year mortality at 10 years 3.4 percent versus 1.9 percent).
As the article indicates, this is probably just the beginning of more heated discussions but I gave my PCP fair warning a couple of years ago that if I get a DCIS diagnosis I'll just smile and wave and keep it moving.
Listen, I don't want to say I told you so or anything but merely thinking about this issue has been enough to raise my blood pressure ever since I had breast cancer in 2009. That experience has shown me that it is absolutely criminal to tell any woman that she has breast cancer when there was no evidence that DCIS would ever develop into cancer. Calling it "pre-cancer" or "Stage 0 cancer" doesn't prevent women from going through absolute hell: disrupting their emotional lives, their work, their relationships, their feelings about their bodies, causing them to go through painful, disfiguring treatment with many negative side effects, and giving them a fear that never really goes away.
From the NY Times article:
Diagnoses of D.C.I.S., involving abnormal cells confined to the milk ducts of the breast, have soared in recent decades. They now account for as much as a quarter of cancer diagnoses made with mammography, as radiologists find smaller and smaller lesions. But the new data on outcomes raises provocative questions: Is D.C.I.S. cancer, a precursor to the disease or just a risk factor for some women? Is there any reason for most patients with the diagnosis to receive brutal therapies? If treatment does not make a difference, should women even be told they have the condition?
~~~~
This is the first I've heard of a serious research project around DCIS. Last I checked, the state of the research was that no study had been performed on woman diagnosed with DCIS who had declined treatment and that autopsies performed on women (for other reasons and not in any systematic way to research DCIS) seemed to indicate that about 15 percent of women died *with* DCIS, but not *of* DCIS.
From The National Center for Biotechnology Information:
At 10 years following DCIS diagnosis, overall breast cancer mortality consistently is less than 2 percent.295–297 In official publications, the SEER registries report 0 percent breast cancer mortality after 5 years, reflecting the belief that there is no mortality from DCIS unless there is an invasive recurrence or new invasive primary tumor, in which case the mortality would be attributed to the recurrence or new tumor.4 Ernster5 estimates 0.7 percent breast cancer mortality within 5 years and 1.9 percent within 10 years for women diagnosed between 1984 and 1989. Ernster also reports that breast cancer mortality declined significantly between 1978–1983 and 1984–1989 (10 year mortality at 10 years 3.4 percent versus 1.9 percent).
As the article indicates, this is probably just the beginning of more heated discussions but I gave my PCP fair warning a couple of years ago that if I get a DCIS diagnosis I'll just smile and wave and keep it moving.
This post was deleted for the following reason: Sorry, the "let me tell you my take on it" framing on this is more suitable for a personal blog post than for a MeFi post. -- LobsterMitten
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