Stage 0 Breast Cancer: Should we do anything about it?

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Radiologyassistant.nl

Stage 0 breast cancer, known in the medical community as Ductal Carinoma In Situ, is the earliest phase of the disease. If you’re going to have breast cancer, you want it to be caught while it’s still at Stage 0. There are two kind: diffuse (it has spread a bit, but hasn’t gone crazy) and concentrated(not the official term, but it means that it’s localized in one area).

Many women won’t know they have stage 0 cancer because it doesn’t form big lumps that you can feel. They way it’s often discovered is from a mammogram. These are scans that women aged 45-54 are recommended to have on a yearly basis. On a mammogram you’ll see white specs and shadows, that you don’t see in a scan of a healthy breast. A biopsy(taking a sample of the breast tissue) will help physicians get a sense of how serious the cancer is.

After these tests are completed, doctors may either suggest you don’t do anything further, other than come in for routine check-ups to see how fast the cancer is growing, if it continues to grow at all. The other path is to take out the portion of the breast that is diseased (lumpectomy or mastectomy) and follow it up with radiation and chemotherapy. While this has become the standard of treatment, recent studies have called it in to question.

For instance, a paper in the Journal of the American Medical Association showed that radiation after lumpectomy did not increase these women’s chances of survival. So in other words, a technique that is commonly used to prevent cancer from coming back, was shown to be useless. Radiation can be very damaging to your body, so you want to avoid it if possible. It can cause lung inflammation, skin irritation and in some rare cases, it can actually cause a second cancer to develop.

This study also showed that women with DCIS have almost the same* amount of risk of dieing(5.4%) from breast cancer as those without DCIS(3.3%). If you were diagnosed with DCIS before age 35 you were at greater risk of dieing of breast cancer after 20 years. They also found that ethnicity can play a role in cancer survival and that black women diagnosed with DCIS were more likely to die of breast cancer compared to non-Hispanic whites.

These findings are interesting and provocative, especially when you compare this against everything you know to be true about breast cancer. I urge you to do a little google searching to see what other people have to say about this topic. For more reading check out Breastcancer.org where they wrote a review of this paper and raised some interesting points, as well ask highlighted some weaknesses. Here is also another editorial that discusses the progress, or lack of progress, the field has made in treating DCIS. Cancer is a tricky disease, and it looks different in every patient. Doctors want to get ahead of the illness before it gets too far, but being efficient with care is also an important consideration. But don’t let me form your opinions, I really just want to provide the information.

Ultimately, more screening means that we will find more cancer. However, we need to be able to tell the difference between cancer that is going to spread violently and cancer that won’t change much over the course of a decade. This means that women might not have to suffer from intensive treatments and instead find more comfortable ways to live with the disease.

*although, one could legitimately say that the risk is almost double, I found it worthwhile to point out that the numbers are also close
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