Ductal Carcinoma In Situ (DCIS) is a cancer we've addressed frequently, particularly in recent weeks while tracking the medical developments of Food Network star Sandra Lee. When Ms. Lee announced earlier this month that she would undergo bilateral mastectomy for her DCIS, we initially pointed out this probably wasn't the correct medical decision, but certainly, we respected her personal choice. Now we're seeing that there's more data supporting our original position.
With the advent of better technologies and more frequent screenings, the diagnosis of DCIS -- the presence of abnormal cells in the milk ducts -- has skyrocketed over recent decades from three percent of breast cancers to about 25 percent. However, how much of a threat these cancers pose has long been in question. Some studies have shown that removing these cells does not lead to a reduction in more invasive breast cancers. This is in contrast to what we see in other cancers such as colon, where the removal of polyps does, in fact, lead to a reduction in the life-threatening disease.
A new study from JAMA oncology reinforces the idea that DCIS may not deserve immediate medical attention. Researchers used data from the Surveillance, Epidemiology and End Results, which provided access to 18 databases. Tracking 108,196 women over 23 years, they were able to follow them for an average of 7.5 years.
The authors, led by Steven A. Narod, M.D., F.R.C.P.C., of the Women s College Hospital in Toronto, estimated that the 10-year breast cancer-specific death rate after DCIS diagnosis was 1.1 percent, while the rate at 20 years was just 3.3 percent. They also reported that the mortality rate did not decline when women chose lumpectomy and radiotherapy treatments after a DCIS diagnosis, and that there were no consistent mortality predictors for the fraction of DCIS diagnosis that led to a breast cancer-specific death.
These data show that the overwhelming majority of women who are diagnosed with DCIS do not die of breast cancer. Given this information, it is probably better for women who do receive a DCIS diagnosis to have a physician monitor their condition, but not seek treatment for these apparently innocuous cells.
Getting back to Ms. Lee, what upset us here at the American Council was that she decided to put on her doctor s lab coat and advise all women, regardless of age, to get a mammogram. This is where we interceded, pointing out that her advice is very dangerous. For women in their 20 s, who do not have additional risk factors (like genetics), receiving mammograms is very low-value health care. It will likely lead to unnecessary tests, procedures, and worry, while not improving womens' health. What so many people don t realize is that not every growth is life threatening, and that not every procedure to remove indolent growths is safe: a lesson Sandra Lee unfortunately learned as she struggled with post-op infection. DCIS has risks, certainly -- but so do these tests, procedures and treatments.
The choice is personal. But all available data should be weighed when any women makes the decision to seek treatment or not. For DCIS, women should weigh the 3. percent, 20-year breast cancer mortality rate against the risks that surgery and/or radiation can present (such as anesthetic reaction and post-op infection).