A Breast Cancer You May Not Need to Treat

An increasing number of women are being told they have "stage 0” cancer and need some combination of surgery, radiation and powerful drugs. Some experts now say these treatments are going much too far.

By Nancy F. Smith
breast cancer nude topless woman picture
Photograph: Sean Locke

There isn’t exactly a groundswell of support for changing the name, but researchers are making great progress in deciphering the biological markers that can distinguish between DCIS cells that are truly dangerous and those that aren’t. Until we know more, many experts believe the only option is to treat them all as if they’re destined to break out of the milk ducts and into the remaining breast tissue. “Sometimes, with surgery, radiation and tamoxifen, we end up treating DCIS more aggressively than we do some invasive cancers,” says Love. “It’s a crime that we don’t really know what to do.”

Mammography reveals only 50 percent of all breast cancers, according to a major study. The other half are found by the woman, and these so-called interval cancers are often far more aggressive than those found in regular screenings. If they didn’t show up on your mammogram, they may have developed quickly—and fast-growing tumors are worrisome. This means the breast self-exam maintains a critical role in monitoring your breast health. “What we don’t think is a good idea is the very detailed breast exam where you worry about every lump,” says Laura Esserman, MD, of the UCSF School of Medicine. When the U.S. Preventive Services Task Force suggested in 2009 that breast self-exams weren’t effective, that’s the kind they were describing. “But a 30-second exam every month or every couple of months in which you simply monitor your breast for any changes, that’s absolutely important,” Esserman says. If you find something new, bring it to the attention of your physician, even if you recently had a mammogram that was normal.

You just got a call from your doctor reporting something suspicious on your mammogram. To find out what it is, you’ll need a biopsy—a crucial step in your diagnosis. Before you freak out, keep in mind that a whopping 80 percent of all breast biopsies turn out to be benign.

There are two ways to retrieve tissue from your breast. With a core-needle biopsy, the doctor, usually a radiologist or breast surgeon, inserts a hollow needle and draws out some of the tissue. If she can feel a lump, she manually guides the needle to the correct spot. If the lesion isn’t big enough to be felt, which is most likely the case with DCIS, she will use a mammogram, ultrasound or MRI to get the needle to the correct spot. Needle biopsies are minimally invasive, can be done with a local anesthetic (think of your dental visits) and offer little risk of infection and almost no scarring. It is the standard of care for breast biopsies.

Surgical biopsies are called for in the rare cases when the lesion is too deep for a needle to reach. A surgeon makes an incision of about an inch and removes some tissue. The procedure is usually done on an outpatient basis, with local anesthesia. Stitches close the incision, which can leave a scar. Although these biopsies are necessary in fewer than 10 percent of suspected breast-cancer cases (of all types), a recent study found that they are performed in as many as 30 percent. If your doctor recommends a surgical biopsy, ask her why. If you don’t like her answer, get a second opinion.

Once retrieved, the tissue goes to a pathologist, who examines the cells with a microscope. The difference between a nonmalignant cell and a cancer cell, especially in low-grade DCIS, is often a matter of degree. Samples drawn through a needle are small and may have been fragmented during extraction, making these distinctions even more difficult to discern. If you get a report of cancer, ask that your slides go to another laboratory for confirmation. And go over both the pathology report and your mammogram with your doctor. At each step along the way to diagnosis, human beings who can make mistakes decide your fate. Do your best to make sure they are right.

NANCY F. SMITH, a freelance writer who lives in Austin, Texas, frequently reports on health, personal finance and travel.

Originally published in the September 2011 issue of More.

First Published September 6, 2011

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Michelle Joiner10.26.2011

I would also like to share clinical findings by The Lancet, a recent paper published confirming that radiation therapy after surgery for early-stage breast cancer patients reduces the risk that the cancer will recur or spread 10 to 15 years following treatment. More information here: http://www.nytimes.com/2011/10/20/health/research/20cancer.html?_r=4

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