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Is Ductal Carcinoma In-Situ (DCIS) Breast Cancer or Abnormal Cells?

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Significantly more women changed their preference from a surgical to a nonsurgical option than from a nonsurgical to a surgical option depending on terminology, according to the study…

Ductal Carcinoma in situ

You have been diagnosed with Ductal Carcinoma In-Situ aka DCIS aka pre-breast cancer. Your doctor tells you…

  • “you have noninvasive cancer”
  •  “you have a breast lesion”
  • “you have abnormal cells”

What do you do? The study linked below indicates that women react more strongly to the word “cancer” than they do “abnormal cells.” How strongly you react to your doctor’s words often translates into the therapy you choose. Do you have a mastectomy, chemo, radiation or watch and wait?

What if your doctor could tell you your risk of your “abnormal cells” turning into invasive breast cancer? What if you had a good idea if your DCIS will become actual breast cancer?

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:

I am both a cancer survivor and cancer coach. If you would like to learn more about the many evidence-based, non-toxic therapies to reduce your risk of a breast cancer diagnosis, please scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:


Hormone Testing Could Tell Which Women with Precursor Will Develop Breast Cancer

“Researchers from the Manchester Cancer Research Centre may have figured out how to predict which patients with ductal carcinoma in situ (DCIS) are likely to develop breast cancer…”

The fact is that ductal carcinoma in situ is overdiagnosed, overtreated and doesn’t become invasive breast cancer most of the time. DCIS is not breast cancer.

Terminology Used to Describe Preinvasive Breast Cancer May Affect Patients’ Treatment Preference

“When ductal carcinoma in situ (DCIS, a preinvasive malignancy of the breast) is described as a high-risk condition rather than cancer, more women report that they would opt for nonsurgical treatments…

When DCIS was described using the term noninvasive cancer, 53 percent (208 of 394) preferred nonsurgical options, whereas 66 percent (258 of 394) preferred nonsurgical options when the term was breast lesion and 69 percent (270 of 394) preferred nonsurgical options when the term was abnormal cells. Significantly more women changed their preference from a surgical to a nonsurgical option than from a nonsurgical to a surgical option depending on terminology, according to the study…

Surgical Margins and Breast Cancer (both DCIS and Invasive)

I was surprised to learn that there is not really any consensus among breast cancer surgeons as to what constitutes a “negative margin.”

An article about a recent study, “Comparative Effectiveness of Ductal Carcinoma In Situ Management and the Roles of Margins and Surgeons,” has been titled “Risk of Breast Cancer Recurrence May Depend on Treating Surgeon.”

The research suggests that a 30% recurrence rate for those who were treated for DCIS could have been avoided with larger surgical margins and radiation treatment.  It says that “long-term health outcomes (disease-free survival) depend on the treatments received.”   “Disease-free survival” means that the DCIS did not recur.  It does not mean that those who had recurrences died.   It is also unclear how many, if any, of the DCIS, recurred in the form of invasive cancer.

The study is retrospective and includes 994 women diagnosed with DCIS between 1985 and 2000.  In looking at the facts about the population included in the study, I found that 853 (85.8%) had DCIS detected by mammogram.  That means that 14.2% of the DCIS was detected because it was in some way palpable, thus making it more likely to progress to invasive cancer.  In my mind, that means it should be treated more aggressively than some DCIS detected with mammography.  I also believe that there are characteristics in some DCIS that make the more aggressive treatment a reasonable decision.  This includes high nuclear grade, comedo status, necrosis, and multi-focal.

The article is very well written and explains some of its limitations.  It also lists percentages of some factors that make DCIS more likely to progress to invasive cancer, such as necrosis and histologic subtype.  It does not, however, reveal which conditions led to recurrences.  Nor does it mention if there were any deaths due to DCIS.

I was surprised to learn that there is not really any consensus among breast cancer surgeons as to what constitutes a “negative margin.”  I do know that my surgeon had to remove considerable extra tissue after her first excision in order to obtain what she thought was a suitable margin.  Today I went back to my pathology report and learned that the first result was only 0.05 mm in thickness for the “deep margin.”  The “remaining margins” were “grossly negative” by more than 1 cm.  Perhaps this means that my surgeon considered 1 cm. to be an adequate margin.  Apparently an “interoperative consultation” was conducted after which a resection of the “deep margin” was done and a margin of greater than 1 cm. was obtained.  I feel fortunate that I did not have to return for a second surgery.

The size of surgical margins is not standardized in the case of DCIS or invasive cancer.

In this article, they seem to believe that there should be some standardization of acceptable margins.  While I am sure there would have to be exceptions, I believe it makes sense to at least have some kind of agreement on what would be optimal.  On the other hand, I hope that surgeons and patients will continue to have the right to make what they consider to be their own informed decisions.  There are many differing opinions on the best options for DCIS and many women with low-grade DCIS may want to decline mastectomies, radiation therapy or five years of tamoxifen.

The article mentions that some of the differences in treatment may be because women may tend to select physicians who will treat them the way they want to be treated.  In other words, if they want to be treated aggressively they would likely choose a physician who wants to treat aggressively.  If they want to take an approach that differs from the gold standard, they will likely seek a physician with a reputation for being willing to accept their decisions.

In rereading my pathology report I noticed that my removed specimen was “greater than 90% invasive carcinoma” and “less than 10% in-situ carcinoma.”  I can only assume there was some DCIS in the lump they removed.  I have to wonder about its presence there and why there was none in the rest of my breast.  I understand why there is so much confusion about DCIS.

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:


Recommended Reading:


Comparative effectiveness of ductal carcinoma in situ management and the roles of margins and surgeons.

“The high incidence of ductal carcinoma in situ (DCIS) and variations in its treatment motivate inquiry into the comparative effectiveness of treatment options. Few such comparative effectiveness studies of DCIS, however, have been performed with detailed information on clinical and treatment attributes.

METHODS:

We collected detailed clinical, nonclinical, pathological, treatment, and long-term outcomes data from multiple medical records of 994 women who were diagnosed with DCIS from 1985 through 2000 in Monroe County (New York) and the Henry Ford Health System (Detroit, MI). We used ipsilateral disease-free survival models to characterize the role of treatments (surgery and radiation therapy) and margin status (positive, close [<2 mm], or negative [≥2 mm]) and logistic regression models to characterize the determinants of treatments and margin status, including the role of surgeons. All statistical tests were two-sided.

RESULTS:

Treatments and margin status were statistically significant and strong predictors of long-term disease-free survival, but results varied substantially by the surgeon. This variation by surgeon accounted for 15%-35% of subsequent ipsilateral 5-year recurrence rates and for 13%-30% of 10-year recurrence rates. The overall differences in predicted 5-year disease-free survival rates for mastectomy (0.993), breast-conserving surgery with radiation therapy (0.945), and breast-conserving surgery without radiation therapy (0.824) were statistically significant (P(diff) < .001 for each of the differences). Similarly, each of the differences at 10 years was statistically significant (P < .001).

CONCLUSIONS:

Our work demonstrates the contributions of treatments and margin status to long-term ipsilateral disease-free survival and the link between surgeons and these key measures of care. Although variation by the surgeon could be generated by patients’ preferences, the extent of variation and its contribution to long-term health outcomes are troubling. Further work is required to determine why women with positive margins receive no additional treatment and why margin status and receipt of radiation therapy vary by surgeon.

 

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