Breast cancer: unnecessary surgeries

Every year about 60,000 American woman are diagnosed with an early stage of breast cancer, known as "Stage 0." As a result, nearly every one of these woman has either a lumpectomy or a mastectomy—often a double mastectomy. A new study has shown that most of these painful and deforming surgeries are unnecessary.

This particular kind of “cancer” is called D.C.I.S., which stands for ductal carcinoma in situ. It’s a small pile-up of abnormal cells in the lining of the milk duct. You can’t feel a lump, but the cell cluster can be seen in a mammogram (which I avoid.). A new study, reported in JAMA Oncology concludes that these surgical treatments make no difference in the patients’ outcomes. To arrive at this conclusion, the study analyzed data from 100,000 patients over 20 years.

Even though 60,000 cases of D.C.I.S. are now being found each year, the incidence of invasive breast cancer has not dropped (it remains at about 240,000 cases a year). Patients who had been surgically treated for D.C.I.S. had about the same likelihood of dying of breast cancer as women in the general population—about 3.3 percent. Those who died did so despite the treatment, not for lack of it. Some who died of breast cancer ended up with the disease throughout their body without ever having it recur in their breasts (those who had undergone mastectomies had no breasts).  In these cases, the cancer had already spread by the time of detection. As for the rest, they were never going to spread anyway. The cell clusters would either disappear, stop growing, or just remain in place and never cause a problem.

Dr. Steven Narod, the lead author of the paper and director of the Familial Breast Cancer Research Unit, Women’s College Research Institute (Canada) says “I think the best way to treat D.C.I.S. is to do nothing.” To choose to do nothing takes courage.

For another view on making this decision, see this article. For a breast cancer surgeon's view of this topic see this article.

Next week: Prostate screening--yes or no?

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