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Calming Counsel About Breast Cancer

Surprising study not whole story, says breast surgeon 

Recently announced research findings have raised questions about breast cancer treatment

By Kathleen Ziemer

Once patients overcome the shock of a cancer diagnosis, they often have a stream of questions to ask:  How advanced is it? Do I need surgery? What are the side effects of chemotherapy?  Will I be okay?

The amount of information a patient is provided or reads online can be overwhelming. A recent study left women who were diagnosed with pre-invasive stage breast cancer with even more questions, but an expert from Rush suggests that the new research is not a cause for change or concern.

The research published in JAMA Oncology on Aug. 20 suggests that the mortality of women who were diagnosed with ductal carcinoma in situ, or stage O breast cancer, does not change regardless of their treatment. DCIS, as it’s known, is cancer that is found in a milk duct of the breast but hasn’t spread beyond the duct. It is considered pre-cancer, because some cases can go on to become invasive.

DCIS is the most common noninvasive or pre-invasive form of breast cancer. The American Cancer Society estimates that there will be 60,000 cases reported in the United States this year.

Calling care conventions into question

Conducted by researchers at two Toronto hospitals, the study of more than 100,000 women with DCIS found that their mortality was 3.3 percent within a 20-year timespan. In other words, 97 percent of women diagnosed with DCIS have the same chance as dying within 20 years as anyone else in the United States. 

The results have raised questions about whether the near universal treatment of DCIS with lumpectomy (surgical removal of the cancer) or mastectomy (removal of one or both breasts) is necessary. “I think the best way to treat DCIS is to do nothing,” the study’s lead author, Steven Narod, MD, told the New York Times

Does this study mean women diagnosed with DCIS who opted for lumpectomy or a mastectomy underwent an unnecessary and disfiguring procedure? Some experts say no.

“This is an interesting study, but it’s inconclusive,” says Katherine Kopkash, MD, a breast cancer surgeon at Rush University Medical Center. “There are other factors that need to be taken into account.”

A SEER, but not a complete insight

Kopkash observes that this research was a Surveillance, Epidemiology and End Results Program based study, and lacks information about registrants’ genetic background and tumor biology. A program of the National Cancer Institute, SEER is a system of coordinated cancer registries in the U.S. that collect information about patient demographics, tumor sites, cancer markers, cancer stage, first course of treatment and survival.

“The genetics and complete tumor biology of a patient are very important for planning treatment,” Kopkash explains. “We have no way of knowing which patient with DCIS will go on to have invasive cancer and who won’t.”  

When confronted with a DCIS diagnosis, patients often panic depending on how they receive the information. The diagnosis often comes from a primary care physician or radiologist, who may not have the ability to explain proper treatment paths.

Kopkash suggests women find a multidisciplinary medical team that includes a breast surgical oncologist, breast medical oncologist and breast radiation oncologist whose goal is to support the woman in finding the treatment that is right for them.

“The study is good news, but is not the full picture for patients with DCIS,” Kopkash concludes. “Breast cancer treatment has radically changed in the last 40 years to include less invasive procedures, and this trend continues. Our goal is to provide the least amount of treatment to get rid of the cancer and preserve a high-quality of life for patients.”

 

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