General Medical · Health

Breast Health: Breast Cancer Prevention and Early Detection Both Save Lives

1) I had a mastectomy for DCIS. Does that mean I was “overtreated” and would have had the same outcome with lumpectomy?

breast-cancer-coverNot at all. One of the biggest sources of confusion about the JAMA study and the Time magazine article is that they didn’t clarify well enough that there is no one-size-fits-all treatment, and that eligibility for different approaches, everything from watchful waiting to bilateral mastectomy, can only be determined on a case-by-case basis. Patients in the JAMA study were not randomly assigned to different treatments all ending up with the same excellent outcomes. Many patients included in this study were advised to undergo particular treatments based on what their doctors felt was the best approach after considering the specifics of the particular case. For example, often women who have large areas of DCIS in their breasts that would be difficult to remove in a small operation are advised to undergo mastectomy. With mastectomy, a woman with DCIS has an extremely low risk of cancer coming back, and an extremely high likelihood of survival. To assume that you could take this same woman with a large area of cancer, perform a lumpectomy (thereby possibly not removing all the cancer) or do no treatment at all, and expect the same outcome would be completely wrong. And in no way did this study show that this would be reasonable to expect.

There are also other mitigating circumstances that may lead us, the surgeons, to advise a woman to have a mastectomy. For example, women with the BRCA gene mutation are at much higher risk for cancer recurrence after lumpectomy, and mastectomy is frequently advised. For many women both lumpectomy and mastectomy would be associated with equal outcomes in their particular cases, and some of these women choose to have a mastectomy. For these women there are other factors that drive decision making beyond just equal survival rates, and in my experience, the choices my patients make are usually well thought out and made after careful consideration and consultation regarding the risks and benefits of all their options.

RELATED: Five Women Directors Tackle Breast Cancer

Women who choose a “watch and wait” or no treatment approach via various research protocols (described in detail in the Time magazine article) are also carefully selected to be the patients who are at lowest risk for having disease progression, and they are carefully monitored. In addition, it should be clarified that while many of these patients undergo no surgical treatment, they often take anti-hormonal therapy which is a form of treatment.

To reiterate, there is no one size fits all. And this holds true for women with DCIS as much as for any other scenario. Perhaps one reason why women with DCIS have such good outcomes is in part because we, the surgeons, are making reasonably good recommendations on a case-by-case basis as to whom should receive which type of surgery. Read More »

Next Page: If more extensive surgery and treatment does not lead to better survival does that imply that having no treatment at all (i.e., “watchful waiting”) is equally as acceptable?

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  • Ricel February 2, 2016 at 5:33 pm

    Hi Dr. Elisa Rush Port,

    Thank you so much for this post. I never thought that being obese is also one of the risk factors for breast cancer. Everyone especially women must keep being physically fit and healthy to avoid this risk.

    This article is such a wakeup call for everyone. I find it very insightful. Thanks for sharing!