Study sparks debate on treatment for early stage breast cancer

A new study released Thursday sparked a debate on the importance of treatment options for women diagnosed with the earliest stage of breast cancer.

The study found that treatment such as radiation for women diagnosed with with DCIS —ductal carcinoma in situ — or stage 0 breast cancer does not eliminate the threat of breast cancer at 10 years. However, researchers studied 100,000 women diagnosed with DCIS for 20 years, and found 97% of them did not die from breast cancer after undergoing treatment.

About 60,000 women are diagnosed with DCIS each year, according to the American Cancer Society. Stage 0 breast cancer is non-invasive and is located only in the milk ducts of the breast, according to breastcancer.org.

The study, published in the JAMA Oncology journal, reignited a debate as to whether or not DCIS qualifies as cancer, and encouraged doctors to research the risks of DCIS more to determine the best treatment options for patients.

Authors of the study argue DCIS should be considered cancer and should be treated as such, while others say aggressive treatment may not be necessary.

Steven Narod, the lead author of the study and a researcher at the Women’s College Research Institute in Toronto, said the 3% of women who died over the 20 years passed away after the DCIS spread throughout their bodies before the lump in their breasts was removed.

“If this can spread prior to the removal and kill you, that’s cancer,” Narod told USA TODAY. “If that’s not cancer, I don’t know what is.”

However, for others, the findings from the study suggested aggressive treatment, such as lumpectomies, lumpectomies with radiation, and mastectomies, is often unnecessary.

Otis Brawley, chief medical officer at the American Cancer Society, told USA TODAY he believes DCIS does not qualify as cancer, and treatment is often unnecessary for women with it. He's not alone: He said a third of doctors believe DCIS is not cancer, a third believe it’s pre-cancer and another third believe it’s cancer.

“It’s a spectrum that goes from white to black, and all of us are arguing about at what point you call that spectrum black,” Brawley said. “To me, my dark gray could be someone else’s black.”

He said the new study tells doctors more work should be done to assess the risk of DCIS for women. He said science should get to the point where doctors can tell women with DCIS whether they need aggressive, hormonal or observational therapy to lower the risk of mortality.

Doctors use mammograms to diagnose women with DCIS. Brawley said the number of women with this diagnosis has grown since the 1970s because of the development of new technology used for mammograms. Women in the study underwent lumpectomies, mastectomies, double mastectomies or radiation for treatment.

He said calling DCIS cancer may result in unnecessary panic and worry.

“We’re causing people to have tremendous angst, and tremendous emotional damage because of the name,” Brawley said.

In an editorial published alongside the study, Laura Esserman, a breast cancer surgeon and researcher at the University of California, San Francisco, and Christina Yau, an assistant professor at the university, argue the study shows aggressive treatment may not be needed.

They wrote the new data suggest DCIS “should be considered a ‘risk factor’ for invasive breast cancer and an opportunity for targeted prevention.” They also said radiation treatment should not be offered as a treatment following a lumpectomy because it “does not affect mortality.”

The study also found death rates as a result of DCIS were twice as high for women under 35 when diagnosed and African- American women. These rates, however, were still lower than those for women with more invasive stages of breast cancer.

Like Brawley, Narod said he believes more research on DCIS is necessary. He suggested investigating the use of chemotherapy after a lumpectomy to discover whether there’s a decreased risk of mortality. The lumpectomy would remove the tumor from the breast  and would be considered a local occurrence since the disease has not spread to other parts of the body.

“We might be able to save some lives,” Narod said of the possibility.