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.
I can’t believe it is over a year since I posted. I had my mammogram last week, and going to an excellent facility really makes the process easier. When I arrived, I requested that my x-rays be read while I wait, since I have to travel to get to this better than average women’s center. They were more than happy to oblige, and I only had to wait five minutes while one of the three radiologists read them. So I left without the fear of a callback. Once you’ve had callback, you know that getting a routine screening leaves you a bit uneasy until you get the letter saying that everything is okay.
Also, I was asked if I wanted a 3D mammo and while I have not researched this extensively, I did read that it emits more radiation. The radiation in the standard mammogram troubles me, so I told the technician I will stick with the regular one.
I have not done any additional research on the value of mammography other than to discuss it with my doctor. Although I have concerns about this path, I have not yet been able to find a better solution to the problem of this screening. I just don’t want to take a chance and skip it when all the leading physicians and organizations are in agreement on this one thing. Does it cause unnecessary biopsies and does it fail to catch fast growing cancers? Yes, on both counts. But again, there is no perfect screening and right now, this is the only thing acceptable to my doctors so I will stick with it, but I am certainly open to other ideas.
One thing that might help is to go two years instead of one, according to new research. This way, there will be a reduced amount of radiation, but the routine stays in tact. I did wait 15 months–not 12–to get mine. I generally do push the limits for many screens, knowing that guidelines are probably more stringent than they need to be. That annual breast cancer screening is still the norm is suggested by the fact that the technician mentioned my tardiness and asked if I had trouble getting an appointment. I just told her no. Anyway, I am glad that’s over and I will probably do it again in another 12 or 15 or 24 months.
Sympathetic doctors are not hard to find. Many doctors do have a bedside manner, they are sympathetic, and they make us feel good. We have confidence in them. But the truth is that while sympathy can be dished out quite readily by physicians with charismatic personalities, their advice may be influenced by the current thinking, which is not always the best thing for us. That is, there is a lot unknown, and doctors fear taking a leap by going with their gut, so they vie on the safe side. You may be thinking, that’s a good thing. Doctors should not take unnecessary risks.That seems logical, but what about the risks that interventions come with? Screening, surgery, radiation and chemotherapy are not risk-free choices. For many conditions outside of the breast cancer realm, the cure is sometimes worse than the disease, so even with a diagnosis of cancer, patients need to exercise caution and not hurry into treatments just because one doctor makes a recommendation.
Dr. Laura Esserman is one doctor who does understand the issues and more than merely sympathizing, she understands the frustration that patients experience. Interviewed at the San Antonio Breast Cancer Symposium, Dr. Esserman speaks about the problems that patients experience when they are diagnosed and treated. This is an excellent video to view whether you are just curious about the mammogram controversy, the difference between high and low risk cancers, and the importance of clinical trials.
In the video, Dr. Esserman announces the creation of the Athena Breast Health Network in California and recommends that patients be proactive and look into clinical trials when they are faced with decisions about breast cancer treatment. She refers listeners to breastcancertrials.org where breast cancer trials around the nation are listed.
The present thinking is to treat DCIS early, but there are really no studies to back up this manner of thinking. It is defensive medicine at its worst. Take a look at Part 3 of a wonderful interview with Dr. Laura Esserman who makes a case for possibly not intervening even when DCIS is discovered. It is an enlightening and refreshing take on this controversial issue.