The Dilemma of Stage 0 - DCIS

In the news lately, there has been significant questioning of the treatment of a particular type of breast cancer known as ductal carcinoma in situ or Stage 0 breast cancer. This is a commonly found cancer that unfortunately affects approximately 60,000 women each year.  

This brief Q & A below touches on the situation that many women face each year.  We hope that these questions and answers help educate the reader about the significance of this new information.  

Q. What is DCIS?
A. DCIS stands for ductal carcinoma in situ. It is a small pileup of abnormal cells in the lining of the milk duct. You cannot feel it because there is nothing to be felt; there is no lump. But the cells can be seen in a mammogram, and when a pathologist examines them, they can look like cancer cells. The cells have not broken free of the milk duct or invaded the breast. And they may never break free. The lesion might go away on its own or it might invade the breast or spread throughout the body. That raises questions about what, if anything, to do about it.

From a thermography perspective:  Thermal imaging does NOT see structure, only heat.  In this specific situation, we likely wouldn’t “see” the abnormal pileup of cells on your thermogram. Thermal imaging is not meant to replace other imaging that can detect structural pathology. 

Q. Is DCIS cancer?
A. It is often called Stage 0 cancer, but researchers say their view of cancer is changing. They used to think cancers began as clusters of abnormal cells, and unless destroyed, the cells would inevitably grow and spread and kill. Clusters of abnormal cells like DCIS can sometimes disappear, stop growing or simply remain in place and never cause a problem. The suspicion is that the abnormal cells may be harmless and may not require treatment. But no one has done a rigorous study comparing outcomes for women who get treatment to those who get no treatment.

From a thermography perspective:  Again, because all cancers behave differently, we may not see any changes on your thermogram, especially if the cells stop growing or remain in the milk duct and not develop further.

The development of DCIS treatments and its handling over the past 40 years is an example of something we in medicine could have done better. ~ Otis Brawley, MD Chief Medical Officer American Cancer Society

 
Q. How many women get a DCIS diagnosis each year?
A. Approximately 60,000 women in the United States are diagnosed annually with DCIS.  Alarmingly, before 1983 (before widespread use of annual screening mammography) only several hundred women were diagnosed.  Although some blame the rapid rise of DCIS on mammography (and the results of radiation exposure on breast tissue), others believe the increase in DCIS is due to the higher effectiveness of computer-assisted detection offered in some mammography clinics. 

From a thermography perspective:  The highest rates of detection are found only when thermography AND mammography are combined at a reasonable interval of time.  When performed together, detection rates are reported at 90-93%.
 
Q. What are the treatment options for women with DCIS?
A. The majority of women get a lumpectomy, sometimes followed by radiation therapy. Other women may choose to have a mastectomy or even a double mastectomy, removing the healthy breast as a preventive measure. 

From a thermography perspective:  Being followed thermographically after a diagnosis of DCIS is extremely valuable.  However, due to the current understanding of DCIS, using other modalities (MRI, mammography, and ultrasound) conjunctively is imperative.
 
Q. What did the new study on DCIS outcomes show?
A. The study analyzed data from 100,000 patients followed over a 20-year timeframe.  Here are the findings: 

• It found that there was essentially no difference in the death rate from breast cancer between the group of women who had lumpectomies with or without radiation and the group of women who had mastectomies.
• In both groups the risk of dying from breast cancer after 20 years was very low, about 3.3 percent.

Understand, a 3.3% risk of dying from breast cancer is very close to the same odds that an average woman will die from breast cancer. 
 
Q. Are some women at higher risk than others if they have DCIS?
A. Yes. Not all women with DCIS will have a 3.3% risk of dying.  Women who fall into this profile have a higher death rate of 7.8% over 20 years:

• Black women
• Women who are under 40 years of age
• Women whose DCIS cells have molecular markers similar to those found in more aggressive, invasive cancers
•  

Q. What should a woman do if she is told she has DCIS?
A. Because pathology is subjective and the stakes with cancer so high, she might want to get a second opinion. If the diagnosis is DCIS, most doctors would urge treatment until a study shows it is not necessary. But some women are choosing not to be treated while getting frequent monitoring. 

You can read more here about this topic.  

These recent reports about the true effectiveness of mammographic screening have caused some breast cancer organizations to take a step back and re-evaluate their routine screening programs.  Switzerland leads the way and recently decided to abolish mammographic screenings all together.  

This article sums it up nicely when it comes to breast cancer stating, 

“Remember that in order to truly avoid breast cancer, you need to focus your attention on actual prevention and not just early detection.”

Remember, thermography is NOT a stand-alone breast cancer detection device, but instead a technology to monitor for changes that could indicate the development of disease.  Prevention requires you to know the risks for developing breast cancer and then take intentional measures to reduce your risk.  Our October newsletter will be focusing on several modalities you can employ to help you reduce your risk.  Prevention is key to changing the course of this disease and unfortunately, this message is NOT being shared.  Please consider helping us spread this message of prevention by sharing our newsletters with others. 

Yours in health…and prevention,

Lynda and Brenda