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Early Breast Cancers May Be Over-Treated

Each year more than 60,000 women in the United States are diagnosed with a type of early breast cancer called Ductal Carcinoma In Situ (DCIS), which represents 25 percent of all breast cancer cases. Almost all DCIS patients are treated with surgery to remove the lump, the entire breast or even both breasts. Two recent studies from different institutions show that women diagnosed with low-grade DCIS who have surgery do not live longer than those who did not have surgery.

In the first study (JAMA Surgery, June 3, 2015), doctors examined data on more than 50,000 cases of DCIS and found that:
• the 10-year survival rate was 98.8 percent for those who had surgery near the time of diagnosis and 98.6 percent for those who did not have surgery. That means that surgery did not prolong the lives of women suffering from this type of early breast cancer.
• Women who had more extensive surgery did not live longer than those who had the far less-invasive lumpectomy.
• For the mildest cases of DCIS, a lumpectomy (surgically removing just the precancerous lump) did not increase survival compared with patients who had no surgery.

The senior author of this study, Dr. Mehra Golshan, who is Director of Breast Surgical Services at Dana-Farber/Brigham and Women's Cancer Center, states that: "We are over-treating breast cancer in the United States, and this study, along with others, suggests the need for treatment strategies tailored to a woman's specific cancer, not just breast cancer in general."

In the second study (JAMA Oncol, published online August 20, 2015), data was collected from 108,196 women with DCIS, with at least ten years of follow-up.
• The overall risk of dying within ten years after being diagnosed with DCIS was 3.3 percent.
• It made no difference in survival whether a woman was treated with a small lumpectomy or removal of the entire breast.
• The death rate from DCIS was the same whether the woman had or did not have surgery.
• Radiation added to lumpectomy helped to prevent recurrences, but did not prolong life over surgery alone.
An editorial on this paper in the same journal recommends that radiation should not be routinely given to every woman diagnosed with DCIS. The lead author of this study feels that after having surgery for DCIS, a woman just needs to be followed by her doctors.

Review of Current Data
• DCIS progresses to life-threatening, invasive breast cancer in only a very small percentage of cases. A working group convened by the National Cancer Institute report that it is not accurate to call DCIS a form of cancer. There is no specific test for breast cancer; it is diagnosed by a pathologist looking at the cells under the microscope and giving an opinion based on how the cells appear.
• Today, surgical lumpectomy is the usual treatment for DCIS.
• Surgery appears to improve survival rate for women with intermediate- or high-grade DCIS.
• Women with DCIS can experience a second primary breast cancer and some will die of breast cancer.

What This Means for Women Diagnosed with DCIS
Since the treatment for early stage DCIS breast cancer is so controversial, doctors need additional studies before they can decide whether surgery is indicated for early stage DCIS. At this point, most doctors recommend simple surgery and some will still recommend radiation also. All women with DCIS should be followed by their doctors.

September 13th, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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