I haven’t written in awhile on DCIS because I have not seen anything new lately, but recently, a well-publicized article caught my attention. While the article focused on the mammogram debate, it also noted that there is new thinking on the DCIS front.
I looked into this. There is nothing very new, but there is a seeming trend towards reconsidering extreme options for treating DCIS. I read another article in the Baltimore Sun titled Doctors Seek to Scale Back Treatment for Common Breast Cancer Diagnosis, which emphasizes the idea that DCIS rarely causes harm, but it can turn into breast cancer. The author notes that DCIS is sometimes referred to as stage-zero cancer, or pre-cancer, and again, this concept is nothing new. However, the subject of risk came up. Do we want to treat a pre-cancer as radically as a full-blown cancer? Studies are cited, and the article includes quotes from physicians, including Dr. Esserman. It is a good article that visits the nuances of decision-making, and why it is still so difficult to know what to do. But does it really point to a new way of thinking? The short answer is, not really. The topic is still very controversial, but with headlines like this, there is a suggestion that perhaps the community is looking into the difficulty in making decisions for those diagnosed with DCIS. It is a recognition that women aren’t just doing what they’re told. They are thinking about their options.
The article looks at choices, such as the one that Angelina Jolie made. At the time her situation became public, I co-authored a blog post titled Angelina Jolie’s Decision at Everything Noetic on why it was courageous for her to have made that choice. Personally, I would vie for watching and waiting as opposed to taking radical action. Of course, it is easy for me to say. When faced with a 5% chance of breast cancer, I decided to do a surgical, incisional biopsy, a procedure that my doctor assured would have removed the DCIS with clean margins had it turned out to be positive. Truthfully, I don’t know what I would do had things gone a different way. Plus, I didn’t watchfully wait, nor did I do the less invasive stereotactic biopsy. It is hard to know what you would really do in any given situation that has not yet occurred.
When it comes to treating DCIS or a suspicious mammogram, I do not think there are right and wrong answers. I do however hope that future research will support a trend away from aggressive treatment.
So I had my mammogram in December. I meant to report this right after I had the exam and now it is March! I am barely blogging with the exception of Everythingnoetic.com, a blog I co-author. (If you are interested in my other projects you can find out by visiting the blog).
What I really liked about the visit is the fact that the mammogram and physician visit was done on the same day. I would highly recommend going to a facility where there is no waiting involved. Facilities that do it all in one day are wonderful and I will continue to go this route.
I will also continue to provide sporadic updates. Obviously, my focus is elsewhere because everything was ok, but I have not forgotten about this blog. Although there is very little interaction, I can tell you that for a blog that is inactive, I continue to get a lot of hits. I really like being able to facilitate the dissemination of information that is so hard to find. Please feel free to comment if you would like me to look into any topic about breast cancer and I will do my best to make time for it. Blessings to anyone who finds themselves here struggling with issues concerning breast health.
Finally, this week, two things came up directly pertaining to breast cancer and I found myself talking about this blog. Yesterday, I went to the Mind-Body-Spirit Expo in NJ and met people from a thermography center. At the booth, they handed out some literature on breast thermography and here is a link to a site with more information on the process. I also posted several links on the page titled LINKS for anyone wanting more information on going the thermography route in NJ. The other thing that came up is that I heard about a book on breast cancer I wanted to check out. If it turns out to be enlightening, I will blog about that next time.
If anyone is using thermography in place of mammograms or in conjunction with them, I’d love to hear what you think about breast cancer screenings!
I listened to Dr. Christiane Northrup‘s Hay House broadcast on October 5th . The subject was breast health. Her guest was thermographer, Dr. Phllip Getson. The discussion centered on breast health in general, but there was a focus on thermography as not only an alternative to mammogram, but also as a way to monitor DCIS!
According to Drs. Northrup and Getson, thermography is a better way to monitor breast changes. It can pick up changes seven to ten years sooner than mammography. It is also very safe. Dr. Getson emphasizes the safety aspect as he explains that it can be performed every day, it can be done on pregnant and lactating women, and children will not be harmed by it. Dr. Northrup adds that many doctors do not recognize the value of thermography. Dr. Northrup has referenced the DCIS controversy in several of her published books, including Women’s Bodies, Women’s Wisdom.
Dr. Northrup did talk about DCIS quite a bit, noting that a study of corpses of women in their forties suggested that 40% of the women studied had DCIS. Yet, these were undiagnosed cases. In other words, when they were alive, the women did not know they had it. Northrup concludes that DCIS is something you die with, and not something you die from. Also reported was a 1995 Lancet study noting that DCIS increased 328% in 12 years, and 200% of the increase was due to the use of mammography.
Dr. Northrup talked about the issue of microcalcifications, and that most doctors feel the need to test them further, often with a biopsy, but that 80% of the time they are benign and goes on to explain further: microcalcifications are present as a result of chronic inflammation in the breast; this is one of the big issues related to mammography; once a doctor finds something, he or she is required to look further; reported data shows that the result of treatment of microcalcifications created more trauma for women; microcalcifications can sit there and be harmless, and you can leave them alone.
Northrup says that DCIS is not harmful. Yet, it must be monitored. Suggested is thermography of the breasts to make sure nothing is growing. If diagnosed DCIS is not generating heat and not changing, it was explained that you can be less aggressive with it. Northrup remarked that many experts believe that DCIS is not a cancer at all, and so many women are being terrified into surgeries that they do not need.
The doctors agreed that DCIS does have to be watched, but it can be watched with the use of thermography. The thermographer looks for inflammation. If there is inflammation,it was explained, then treat the inflammation. Northrup says we have created a nation that is terrified where every single one of us is a sitting duck, but this is a manmade idea. She implores the listener to stop the insanity.
I totally agree. Dr. Northrup has vocalized these sentiments before and where she stands on DCIS is no secret. It is the minority position, but it needs to be heard. Further, much of the information in the broadcast can be corroborated with other sources. While I have heard much of it before–and I even know a bit about thermography, the detailed information provided about the technique and its usefulness in montoring DCIS is something new to me. Thermography in fact can be an avenue that women may take who do not want to be endlessly monitored by mammograms that are potentially harmful and not as accurate. I will certainly do more research on thermography.
Both doctors talked about prevention in the form of supplements to enhance breast health, as well as changes in diet; there was an emphasis on avoidance of sugar. There was a sense that changes in the breasts are not designated to become cancer and lifestyle changes can help to prevent this from happening.
The most important thing I got from this broadcast is that if you are diagnosed with DCIS, you can use thermography as a method of active surveillance. I think there is a lot of wisdom there. First, do no harm, but do follow up. Thermography is not harmful and it provides a lot of information. The only drawback is that while it is an excellent tool, the insurance companies–well, they love the mammogram so they may not pay for the thermogram. It is controversial, but I’ll take something that is completely not harmful over radiation, biopsy, or surgery. Still, I do feel the need to research this controversy further. I am hopeful that thermography or some other alternative will provide help for the millions of women who endure countless mammograms and derive so little information from them.
While most doctors do treat DCIS with surgery, there are some who see watchful waiting as an option.
Thanks to this month’s issue of More Magazine, an article by Nancy Smith entitled “A Breast Cancer You May Not Need to Treat” provides the latest information on DCIS. In it, a handful of doctors who advocate for the watchful waiting approach are interviewed and that part of the piece appears on page 4.
It should be said that while some doctors believe that not taking drastic measures, or even having a biopsy, is possible, it does not seem to be typical. That is, most doctors who see something awry on the mammo will probably advocate for biopsy, and if something turns up there, well, the protocol says to treat it like invasive breast cancer.
It should be emphasized that when a doctor says that one should watch and wait, it should not be construed as “do nothing” and one should not get the impression that everything is fine. Monitoring is key to watchful waiting. It means that you have your mammograms or sonograms or whatever is recommended to make sure that everything is under control. In other words, what the doctors call active surveillance in the Smith article means that you take an active role in watching the cells. You don’t run the other way, terrified of getting the next mammogram. You wait with optimism, and reverence for the process. You listen to your doctors. It seems to be a non-invasive way of potentially saving your life.
Hi. As soon as I titled this blog, I had a good number of hits. Indeed, people are hungry for information on DCIS. Please be patient as I have just begun. I will start with an article titled Prone to Error published in the New York Times last year.
There are so many errors made trying to save women from breast cancer that it brings into question the validity of going on the investigation in the first place. What is the purpose of finding cancer early if diagnosis is full of holes? Most of the examples come from small communities where there are inexperienced pathologists, but even when one receives a DCIS diagnosis from the best pathologist in the world, the diagnosis is still an opinion.
My question is, why not wait? Why not wait to see if the tiny bits of calcification actually grow into something before engaging in last resort treatment, or any treatment at all? Why attempt to even diagnose DCIS if a woman is okay with watching and waiting? These are the questions I am asking, and I know that it is easy to say that a case of DCIS might grow into cancer, and while cure for DCIS is like 98 or 99%, the problem is that even if the DCIS never comes back, it may never have gone on to become invasive breast cancer in the first place. It is a conundrum. I get that. But what I don’t get is why women don’t have a choice in the matter, given the lack of knowledge on the subject. Why can’t the doctors say, “we don’t know what will happen. We don’t know whether these cells will kill you, or won’t do anything at all. Given that, what do you want to do?”