A new study finds treating specific, early breast cancer does little to improve survival rates By Matt McMillen
WebMD Health News Last Thursday, JAMA Oncology published a large study which raises questions about the value of aggressively treating a common type of early stage breast cancer called ductal carcinoma in situ, or DCIS. Stephanie Bernik, MD, chief of surgical oncology at Lenox Hill Hospital in New York City, walks us through the study results and what they mean for the estimated 50,000 women diagnosed with DCIS each year. 1. What did the study find about treatment of DCIS? The study found that women with low grade DCIS who underwent breast surgery had no greater survival rate than women who had no surgery. 2. If DCIS is stage 0, why has it been treated so aggressively? DCIS is a non-invasive type of cancer that has not yet spread beyond the milk ducts where it’s found. However, it is treated aggressively because, if left alone, it will often become an invasive cancer that has the potential to spread to other parts of the body. Unfortunately, we currently have no way to predict whether a woman’s DCIS will develop into an aggressive cancer. 3. Does this study suggest a major shift in how DCIS should be treated? What if doctors don’t agree? The study actually was careful to say that a randomized trial needs to be carried out to determine if less aggressive treatment can be used in some women with DCIS. The authors were careful to state that less aggressive therapy may be something that we do in the future, but we need to investigate it further. They did not fully endorse not treating low grade DCIS, but suggested that perhaps work needs to be carried out to see if this is a viable option. 4. Are there some women who should treat it more aggressively? The study found that survival rates were lower in women under the age of 35. These women should treat DCIS aggressively, although recommendations may change in the future. Again, more study needs to be directed to this group of patients to determine the best course of treatment. 5. How can you know which treatment plan is right for you? When trying to decide on treatment options, a patient needs to determine which treatment is the best fit. There are options, and one size does not fit all. Some women choose breast conservation and others choose mastectomy, often for personal reasons. At times, with extensive disease, the option of saving the breast is not available. 6. What if you disagree with your doctor’s recommendation? Should you get a second opinion? If a patient has any questions that are not settled, a second opinion often helps. For example, if her doctor tells her she needs a mastectomy yet she wants to try and save her breast, a second opinion might help her better understand her options and reach a decision, one way or another. 7. What if someone wants to pursue aggressive treatment, even if it may not be needed? A patient has the choice to pursue aggressive surgery. Some states have passed laws that direct doctors to discuss the option of saving the breast as well as the option of removing the breast. Many women chose a double mastectomy because they want to reduce the chance of ever getting cancer again, even in the opposite breast. They want to decrease the chance of being diagnosed with an invasive cancer that might require chemotherapy. This is viewed as risk reduction surgery and is a legitimate option if a woman wants to go that route. If a patient prefers to pursue a less aggressive, non-standard type of treatment, her doctor will discuss the risks and benefits of such a treatment with her. And sometimes, exceptions have to be made. For example, some women may undergo an excision, which removes just the cancerous tissue and some of the healthy tissue surrounding it, because they cannot tolerate additional treatment. SOURCE: http://blogs.webmd.com/breaking-news/2015/08/treatment-shift-for-early-stage-breast-cancer.html
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