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DCIS Diagnosis- More Art than Science?

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Cases of DCIS have increased 5 fold between 1983 and 2003 in the United States due to the introduction of screening mammography.[29] In 2009 about 62,000 cases were diagnosed.[29]”

If you have had a breast cancer biopsy this year you are one of about 1.6 million people. The good news is that if you were diagnosed with invasive breast cancer, 98% of pathologists would agree on your diagnosis, according to the articles linked below.

Image result for photo of DCIS

The bad news is that if you were diagnosed with ductal carcinoma in situ (dcis) or atypical ductal hyperplasia (atypia) your pathologist’s findings may cause disagreement with other pathologists.

Bottom line- get a second opinion.

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To learn more about DCIS and the evidence-based therapies that can help you prevent its spread into invasive breast cancer, please watch the video below:

 

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Breast Biopsy Uncertainties for DCIS and Atypia

“For the 1.6 million women in the United States who undergo breast biopsy to confirm screening mammogram or breast examination findings, a diagnosis of ductal carcinoma in situ (DCIS) or atypical ductal hyperplasia (atypia) might be unsettling, according to a report published in the March 17 issue of JAMA

If a woman receives a diagnosis of atypia or DCIS, she has time to gather more information and consider asking for a second opinion. She does not need to get immediate treatment; she has time to verify the diagnosis and learn what it means to be at increased risk of breast cancer,” she explained…

In clinical practice, a woman with a diagnosis of DCIS might go through surgery, radiation, or hormonal therapy, much like a woman does if she has early-stage invasive breast cancer. Women with a diagnosis of atypia are potential candidates for annual screening with MRI and chemoprevention, she said.

Expertise vs Evidence in Assessment of Breast Biopsies

Breast biopsies are performed in 1.6 million women in the United States each year1 and yield results ranging from benign to atypical hyperplasia to carcinoma in situ to invasive cancer, each with specific implications for subsequent management. The critical tissue diagnosis from the anatomic pathologist directly determines patient management… The accuracy of the pathologist’s diagnoses is relatively understudied and represents an important knowledge gap at a time when medicine is becoming ever more evidence-based.…”

I’m pretty sure that what this JAMA editorial is saying is that of the 1.6 million breast biopsies performed annually, the pathologist’s determination is everything- diagnosis, stage, prognosis, treatment plan, etc. Unfortunately, pathologists disagree on about 20% of the diagnoses.

These findings are disconcerting but perhaps not all together surprising. Morphologic diagnosis rests on broad acceptance of key criteria, some of which are easily and specifically defined but many of which are very subtle and difficult to describe in words. Diagnoses that rest on well-defined criteria (eg, diagnosis of invasive breast cancer) are more likely to be observer-independent whereas interpretation of subtle criteria such as architectural irregularity and nuclear pleomorphism will vary between observers as a function of training, experience, and perhaps innate cognitive skills.…”

Again, what I think the editorial is saying is that the disagreement among pathologists is understandable considering how difficult it is to see the tiny little changes in a breast that oncs call breast cancer stage 0 or even smaller aka atypia.

Atypical ductal hyperplasia

Atypical ductal hyperplasia, abbreviated ADH, is the term used for a benign lesion of the breast that indicates an increased risk of breast cancer.[1]”

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast.[1][2] DCIS is classified as Stage 0.[3] It rarely produces symptoms or breast lumps, and it is usually detected through screening mammography.[4][5]

Cases of DCIS have increased 5 fold between 1983 and 2003 in the United States due to the introduction of screening mammography.[29] In 2009 about 62,000 cases were diagnosed.[29]”

DCIS Diagnosis: Confusion Over Whether This Is Cancer or Not

“Women diagnosed with ductal carcinoma in situ (DCIS) are frequently confused about the diagnosis, unclear about whether it is cancer or not, and have lingering concerns about how and why they chose to treat it.

These are the findings from a large, national survey of women who were diagnosed with DCIS. The findings were published online on February 22 in Cancer.

“Each year in the United States, nearly 50,000 women are diagnosed with ductal carcinoma in situ (DCIS), a noninvasive breast condition that has little potential to spread beyond the breast,” comment lead author Shoshana Rosenberg, ScD, MPH, Weill Cornell Medicine, New York, and colleagues.

Although there is substantial heterogeneity among DCIS lesions, current estimates are that only 20% to 30% of DCIS cases will advance to invasive cancer over a lifetime, they point out.

Yet current treatment for DCIS is similar to that for invasive breast cancer, which usually includes some combination of surgery, radiotherapy, and/or endocrine therapy. Responses in the survey show that women worry about whether they had enough or too much treatment.

The survey shows that “participants with a history of DCIS reported confusion and concern about the diagnosis and treatment which caused worry and significant uncertainty,” the authors conclude.

 

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Oncotype DX for Breast Cancer and DCIS- better than a second opinion? - PeopleBeatingCancer says 5 years ago

[…] Breast Cancer Biopsy- More Art than Science? […]

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