A Breast That May Not Need Surgery?

Posted on Oct 2, 2015 in My Cancer Type, Research

It seems perfect to celebrate Breast Cancer Awareness Month with news about a breast condition that may benefit from more awareness — and less treatment.
The time may have come to start treating some DCIS like early prostate cancer — watching and waiting instead of treating. Some women with low grade DCIS and low risk tumor genomes may not need surgery. A 23-year retrospective study of 57,222 women found that surgery on low grade DCIS did not save lives from breast cancer. Instead, these women could be managed with watchful waiting (also called active surveillance).

Who does this impact?

Ductal carcinoma in situ (DCIS) accounts for 20-30% of all breast cancer diagnoses. However, DCIS is not really cancer. It is a pre-cancerous condition of the breast. DCIS is most frequently found on a mammogram, and the incidence has risen 500% since the development of mammography.

The problem is that some women with DCIS need treatment, and some don’t. DCIS has varying severities. Low grade DCIS has a low risk of becoming breast cancer and may not need surgery. Intermediate and high grade DCIS have a higher risk of becoming cancer or concealing existing cancer. Women with intermediate and high grade DCIS may still benefit from surgery, especially if their tumor genetics or also intermediate or high risk.

What is active surveillance?

Surgical oncologist Dr Laura Esserman of UCSF explains, “For DCIS, any lesion that doesn’t appear high grade would be left alone and not biopsied. Instead, if suspicious calcifications were discovered in mammography screening, patients would be given the option of forgoing treatment while doctors monitor them intensely to see what develops. This strategy is already used in treating low-risk prostate-cancer patients, who do not undergo surgery or radiation unless the lesion progresses to a higher risk level.”[1]

What kinds of tools are used to monitor my breast during active surveillance? 

Oncologists watch more growth or change in the calcifications on the mammogram. 3D mammography more accurately observes the appearance of breast lesions than 2D mammography does. Genetic testing such as the Oncotype DX DCIS panel can also guide DCIS assessment. Alpha v beta 6 is an investigational metabolic marker which may predict which DCIS lesions are more likely to become breast cancer; watch for an increased role for this test in the future.