• DCIS in the news

    Asked by Frums1 on Tuesday, August 25, 2015

    DCIS in the news

    Is anyone else confused and/or upset with the release of this new DCIS study? I am having a hard time understanding the finding and recommendations. I had a double mastectomy due to DCIS, I still don't think I would have taken a watch and monitor approach.

    18 Answers from the Community

    18 answers
    • geekling's Avatar
      geekling

      It would be easier to offer an opinion if you would show a link to the study wgich is the subject f your concern. Best wishes

      about 3 years ago
    • Frums1's Avatar
    • barryboomer's Avatar
      barryboomer

      YES.....IF I had this and found out that Mortality is the same with or without the horrible surgeries I'd be MAD AS XXX....

      about 3 years ago
    • Beach1040's Avatar
      Beach1040

      I agree, Frums1. I elected mastectomy too & am glad I did, if the cancer shows up again, at least I know I did everything I could.

      about 3 years ago
    • Ejourneys' Avatar
      Ejourneys

      Original article here:
      http://oncology.jamanetwork.com/article.aspx?articleid=2427491

      I recommend reading the sections "Strengths and Limitations," "Interpretation," and "Conclusions."

      As general surgery resident Andrea Merrill writes (https://twitter.com/anjlm7/status/634427498441347072), "Once again @nytimes sensationalizes & overstates conclusion."

      I also found valuable information here:
      http://www.medscape.com/viewarticle/849503

      in which Dr Stephen Feig is interviewed on the subject of BC overdiagnosis. The upshot is that when you look at the long term, overdiagnosis is clinically insignificant and is not the problem that many claim it is. The main focus of the interview is on screening, but a discussion on perceived overtreatment begins on page 3. Excerpt follows:

      Medscape: What do you say to the argument that overdiagnosis isn't a problem, it's overtreatment—you're discovering cancers that are very small and maybe shouldn't be treated?

      Dr Feig: Cancers that are small will eventually become large cancers, because cancers grow. Ductal carcinoma in situ (DCIS), which might be the poster child for what they term "pseudocancer," represents a spectrum of disease. The best way to assess the aggressiveness of DCIS is to look at calcification, because calcification represents cell death and that's the more aggressive type.

      My point is that when a radiologist calls something "possibly DCIS," this is at one end of the aggressive spectrum. We're not detecting that many cases of low-grade DCIS. High-grade DCIS is more apparent on mammography, and by and large, our detection of DCIS is skewed toward the more aggressive kind. This has been found in a lot of studies. Even in the United Kingdom (where the quality of mammography is not great), only about one third of the DCIS was low-grade and about two thirds was intermediate- or high-grade.

      That's similar to the data we have in the United States. In my paper in Academic Radiology, I cited Mel Silverstein (a surgeon in California) and colleagues; in his practice, at least 80% of the DCIS is intermediate-grade or high-grade.

      Medscape: And intermediate- or high-grade DCIS will progress to breast cancer?

      Dr Feig: Yes. Even low-grade cases are going to progress to medium-grade. I have done some studies showing that the proportions of high-grade cases increase over time. In other words, low-grade turns into intermediate-grade because you have cell turnover. Cancers are a mixture of different cells; some are more aggressive than others. And what happens? The higher-grade cells will overpopulate the rest of the cells.

      It's like in Darwinian evolution. The more aggressive cells grow faster and become the predominant cells over time. That's why even low-grade DCIS has the potential to become cancer, although not as fast as intermediate-grade and certainly not as fast as high-grade.

      about 3 years ago
    • barryboomer's Avatar
      barryboomer

      It is WAY too confusing and above my pay grade. BUT I Wonder If they will start seeing cancer cells in places and start to treat them WHEN our immune system just hasn't dealt with them yet. there is a danger in looking and finding runaway cells too early and interfering with the natural process of the immune system which IS TO Control Runaway cells. There is a point where this backfires....

      about 3 years ago
    • Frums1's Avatar
      Frums1

      thank you everyone. @ejourney thank you for the information. I was afraid to google more...
      I'm grateful for a place where I can post my questions and fears

      about 3 years ago
    • Ejourneys' Avatar
      Ejourneys

      Frums1, I get most of my info from #bcsm (breast cancer social media) on Twitter, website http://bcsmcommunity.org/ (many good resources there). #BCSM is a community of patients, doctors and other health care providers, researchers, caregivers, advocates, and other supporters. We hold tweet chats Monday nights at 9 p.m. Eastern, but the hashtag is active 24/7.

      about 3 years ago
    • geekling's Avatar
      geekling

      You aren't the only one feeling confused or betrayed. Try to realise that people can only help based on knowledge they have at the time of the assist.

      http://mobile.nytimes.com/2015/08/21/health/breast-cancer-treatment-and-dcis-readers-react.html

      They gave me more radiation, for example, than you can shake a stick at & mucked up the chemotherapy treatment (which made me decide to submit in the first place...new drugs said to be 95% effective) and, although I blame the #$&("×°^ who lied to me about radiation effects when I asked detailed questions (and he was asked by the hospital to relocate when I asked for a change of doctor ...he admitted to his lies), they only did what they knew how to do then.

      Had the lying radiologist told me the truth, the quality of my life (if any) would, perhaps, have been better but if the dozens of MD professional morons to whom I showed the tumor (over 13years, fer crimineys sake) and asked for its removal had bothered to admit they didn't know how to shine a shoe, never mind diagnose a tumor being pointed out to thrm by the patient, I likely would not have needed any treatment other than a surgery.

      If the cat hadn't tripped me up while I was wearing a pair of borrowed slides made too well (my big toe broke because the shoe wouldn't), had I not been despondent from an inability to walk while running a business & caring for my Mom, I would not have eaten 2 quarts of organic double Dutch organic chocolate ice cream each day as comfort, gained 60+ pounds and finally had a surgeon say "that must be uncomfortable; I can remove it.'as the tumor had grown along with the rest of me, I would not have known what the problem ever was or how to fix it.

      What I am trying to say is the the exploration of alternative realities and infunite possibilities will drive a person mad. Suffice to say you are alive and the Universe works in very odd ways.

      I am glad you are here because you help me to think more clearly.

      Hugz & best wishes

      about 3 years ago
    • cak61's Avatar
      cak61

      Who would want to "wait and see whether this will become invasive"?
      At least remove the dcis.
      I can see not doing more than that, but I would never want to "wait and see"!
      If you removed your breasts, so you never have to worry about dealing with a new case, as a six year surviver who had a lumpectomy, I completely understand.
      I have met too many women who have had to deal with this monster more than once.
      They did not even talk to me about a mastectomy, only saying survival rate is the same for both. What they didn't say was, get rid of the breast tissue and your chances of getting a new case drop to almost zero.
      I have major anxiety when it comes time for my mammogram/US/MRI's.

      about 3 years ago
    • fiddler's Avatar
      fiddler

      Getting rid of a breast does not reduce the chances of getting a new case to zero. It depends on the cancer. For instance, I was diagnosed with triple negative (TNBC). It does not come back in the breast most of the time, but does come back mostly in the liver, lungs and brain.

      A calcification showed up in my breast last Feb. Am I worried? No. My radiologist saved my life because she intuitively caught TNBC at Stage 1A.

      It's so very difficult to stop fretting about cancer returning.

      about 3 years ago
    • AngieStewart's Avatar
      AngieStewart

      I was also diagnosed with DCIS and elected to go with the double mastectomy. I think people make the best decisions for them with the facts they are given at the time and their lifestyle and what works best for them. I had people advise me to take the wait and see approach to see if it would spread or remain the same. For me that was not an option, I wanted it out of my body. I am still really happy with the decision I made, it was what was best for me.

      about 3 years ago
    • Jouska's Avatar
      Jouska

      It is a really interesting article - the full one, not the NY Times. Research is constantly changing treatment and that is a good thing. How wonderful that there is 20 years of research to look at and evaluate and potentially modify treatment. One data point I wish it had is the HER2 status of the women who later developed bc. As someone who is HEr2+ and grateful for research and clinical trials, one wonders if that is a contributing factor to developing an invasive cancer when having had DCIS. Thanks for sharing the articles and research.

      about 3 years ago
    • barryboomer's Avatar
      barryboomer

      Information is powerful....sometimes people get angry with me if or when I post something that may be controversial or a different but I think we should read everything and then make up our own minds. Censorship can kill....Free Speech is best.

      about 3 years ago
    • Jouska's Avatar
      Jouska

      What I got from the full article is that the results of lumpectomy, with or w/o radiation is similar to mastectomy. What I didn't get from the article is that the study didn't really look at no treatment in terms of long term survival. The NY Times article seems to imply that was the study, which, to my non-research or medical mind isn't the case. And i still believe one must make the best choice for oneself, given the knowledge one has at the time.

      about 3 years ago
    • cak61's Avatar
      cak61

      Fiddler, if it "comes back" in the liver, lungs or brain, that would be considered a recurrence. I was speaking of a NEW case in the breast. Prophylactic mastectomy reduces the chance of a new case in the breast by upwards of 90% or more.
      Of course, once we have had breast cancer, there is always that chance of a recurrence showing up somewhere else in our bodies.

      about 3 years ago
    • whirl's Avatar
      whirl

      I have been a women's health practitioner for over 30 years. During this time I have seen many changes in our standard of care. While this example isn't exactly apples to apples here is one.
      In the 80's and 90's if a woman had mild dysplasia pap smear, she almost always would have a colposcopy and then would get cryo surgery to her cervix. One doctor opted to only repap every 3-4 months and he was looked down upon the medical community. There are radical changes today for pap follow up that would would have rocked the medical community back then. Having cryo therapy is not good for the cervix. We did not do the young woman any good. Today's standard of care for mild dysplasia or ASCUS she is giving a test for HPV to see if you carry the bad virus, teens do not get pap smears until 21 no matter what as she clears the virus on her own. Women over 70 do not need pap smears even if she has new partners to name some of the changes in the pap protocol.

      Back to breast cancer. Women in the 50's through at least the 80's would be given a true radical mastectomy. Today they save most of our muscles thankfully. A lumpectomy is often done. We have learned more about the aggressive cancers and ones that do little damage. I truly wonder what our treatment will be in another 20 years. My guess what we do today will be as weird as blood letting in President Washington's time is to us today.

      This chat board is wonderful in the fact we can ask any question and hear from a group of caring women and men. Thanks for all the links to the articles.

      about 3 years ago
    • barryboomer's Avatar
      barryboomer

      Hey Whirl.....In 100 years they will look back on this time as the dark ages of medicine. It will be almost impossible for the people to read in the history books that we Cut off breasts and testicles and NUKE people AND Poison people to try and heal them. I know that's all we supposedly have and that's ok BUT in a hundred years from now they won't look back kindly at this era of cut, burn and poison. OF course they will have some simple DNA Method to just reverse the message and the cancer will be gone and the cells will go back to behaving themselves in what ever organ went haywire. I find it weird that Usually we only get one organs cells malfunctioning and all the others have normal cell cycles.......Wonder WHY in just the one organ while all the other organs are ok? Oh well there I go wondering and asking that pesky question WHY? I'll just shut up and go back in my box....B

      about 3 years ago

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