General Medical · Health

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

2) 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?

Absolutely not. The women included in the JAMA study all underwent treatment of some sort, which ranged from lumpectomy alone, to lumpectomy with radiation, to mastectomy. And with appropriate treatment, excellent outcomes can be expected. The same cannot be said for doing nothing.

The comparison between DCIS and prostate cancer where the watchful waiting approach has been adopted to some extent has been offered as a model to follow for DCIS patients, but in truth, it is not a good comparison to make for many reasons. First, men with prostate cancer for whom watchful waiting is recommended are often elderly and infirm, with other concomitant illnesses that have a higher likelihood of causing death before their prostate cancer progresses. Second, surgical treatment for prostate cancer, a prostatectomy, is associated with a significantly higher risk of serious operative complications (compared to the operations we perform for breast cancer) and one might think twice before recommending this course of action for someone elderly or infirm.

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There is no question that we, as breast surgeons, also think twice before recommending extensive or aggressive treatment for our older female patients, especially when they have other co-morbid conditions. But to assume that a 45-year-old otherwise healthy woman would have no progression of her DCIS over the ensuing 40 years (the current lifespan of the average woman in the United States is approximately 85 years old) is potentially dangerous.

Equally as concerning is the assumption that if no treatment is given, and disease progresses, there is a guarantee that it can be treated later with no compromise in cure or change in outcome. Progression of DCIS to spread throughout the breast or progression from DCIS to invasive cancer is a potentially catastrophic development that could lead to the need for even more aggressive treatment than what was originally feasible: women who were lumpectomy candidates may now require mastectomy. And women who would not have been recommended to have chemotherapy based on DCIS, may now require it for their invasive cancer. True, there may be cases, among the 60,000 women who receive a DCIS diagnosis each year where watching and waiting may be appropriate, where there is no progression, and the disease is stable for years and years. And many of my colleagues are actively engaged in research exploring the watchful waiting approach for some cases. But no one currently has the tools or tests to identify or accurately predict which cases fall into this category. This is an area of extensive research and we welcome the day where we can safely recommend this approach for a real number of patients. Read More »

Next Page: Why a woman considering a “no treatment” approach to DCIS needs to proceed with caution.

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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!