Small breast cancers found earlier, but often overtreated -- study
March 26, 1996
Web posted at: 11:30 p.m. ESTFrom Correspondent Rhonda Rowland
ATLANTA, Georgia (CNN) -- During the last decade, the number of women diagnosed with a particular type of breast cancer has risen dramatically. It is called ductal carcinoma in situ, or DCIS, and is confined to the milk ducts in the breast.
The number of women diagnosed with DCIS is 200 percent higher than 10 years ago, according to a study in the Journal of the American Medical Association. The main reason: Mammograms are used more often now to screen for breast cancers. DCIS is a pre-invasive cancer, said Dr. William Wood of Emory University, who believes that the surge in diagnosis is a good thing.
"The wonderful thing about why we're seeing so much pre-invasive cancer is, with screening mammography, we're finding these very early lesions," he said.
Half of the cancers detected by mammography in the United States today are at this stage.
"The good news is that virtually all these can be treated with complete cure," Wood said. "The bad news is there's still uncertainty as to how little therapy we can give and still get excellent results."
Augusta Collins, 72, was diagnosed with DCIS. In her case, Wood felt lumpectomy, a removal of the cancer and some surrounding tissue, was the best treatment.
"I'm very pleased with the outcome and I'm very pleased with how I feel now, which is good," Collins said.
But the JAMA study found that some doctors are more likely to recommend mastectomy, a removal of the entire breast. More than 10,000 mastectomies were done in 1992 for the treatment of DCIS. Although the proportion of women treated for DCIS with a mastectomy has dropped considerably over the last 10 years, researchers say it's possible that many of those women who did receive mastectomies were overtreated.
"It appears the majority of cases will not go beyond the milk ducts, but the fact that we're detecting these is leading to a great deal of surgery, because we can't really distinguish which women will progress and which will not," said Virginia Ernster, a researcher at the University of California at San Francisco who worked on the study.
Although Ernster says the value of DCIS detection and early treatment is not fully understood, studies show routine mammography in women over age 50 lowers the number of deaths from breast cancer by 25 to 30 percent.
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