New research finds that there’s a low risk of dying from early stage breast cancer
The early stage breast cancer
that they studied is ductal carcinoma in situ (DCIS), a small, localised cluster of cancer
cells. About 20% to 25% of breast cancers that mammogram screening detects are DCIS. It is considered a stage 0 cancer
that does not escape its location in the breast, the researchers said. Cancer
that spreads into the rest of the breast or beyond is “invasive”.
“One clinical implication is to reiterate that DCIS is not an ‘emergency,’ ” said Sarah Hawley, a cancer
research specialist at the University of Michigan in Ann Arbor. “The study supports that the risk of dying is extremely low for these patients.”
Risk factors associated with early stage breast cancer
In an accompanying editorial, Laura Esserman and Christina Yau, both from the University of California, San Francisco, wrote that DCIS looks different in younger women, causing symptoms such as a detectable mass or bloody nipple discharge. Because screening in women under age 40 is rare, they said, these symptoms are usually how younger women end up on the clinical radar.
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Some other risk factors for a rogue DCIS include whether or not it responds to hormones, carries certain versions of cancer-related genes or is 2 inches across or larger.
These risk factors have yet to lead to different treatments for younger women or black women who are diagnosed with DCIS. Hawley said that with further research, more targeted treatments might be possible for women who are at higher risk.
Narod suggested that for populations with the highest risk, at some point, chemotherapy might become an option to deal with DCIS cells that may be lingering somewhere outside the treated breast.
In spite of some heightened concerns for specific high-risk groups, the results are generally promising for women who receive a DCIS diagnosis. Narod points out that the overall risk of dying because of DCIS is “not as bad as having a family history of breast cancer or high-density breast tissue.”
Indeed, Esserman and Yau viewed the results as a reason to reduce a sense of urgency. They write that “given the low breast cancer mortality risk, we should stop telling women . . . that they should schedule definitive surgery within two weeks of diagnosis.”
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