Ductal carcinoma in situ - the need for individualized treatment planning
August 21, 2015
On August 20, 2015, the New York Times published an article with the provocative title, “Doubt is Raised Over Value of Surgery for Breast Lesion at Earliest Stage.” In it they reference a study by Narod reported in JAMA Oncology that looked at breast cancer death after a DCIS diagnosis.
The questions that the author felt his research generated were “What is different about the DCIS that women die from?” and “How is it that young age at diagnosis and black ethnicity were predictors of breast cancer mortality?” These questions are very different than those posed in the New York Times article and are not questions that the study is designed to answer: Is DCIS 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?
The perspective of medical experts is clear. We do not yet have enough of an understanding of DCIS to say that it is safe to not treat. We do know that when DCIS recurs after initial treatment, 50% of the time it will be an invasive cancer that may need significantly more aggressive treatment, including chemotherapy. We continue to individualize treatment based on the woman’s personal characteristics (age, medical conditions, personal values, family history, etc.) and on the specific characteristics of her disease (extent of disease, location within the breast, pathological grade, etc.). Some carefully selected women may do well with observation, many more will need at least some surgery and possibly radiation therapy, and some will have the best outcome with a total mastectomy. All the breast surgeons that I know would happily endorse less treatment (surgery, radiation, medications) if we feel that it has been clearly shown to be safe for our patients.
The bigger take home message for me is this: don’t use the New York Times or other non-medical sources as your primary source of medical information. Get your information from trusted physicians and institutions.