Treating Ductal Carcinoma in Situ

There are many different types of breast cancer and the type with which I was diagnosed was Ductal carcinoma in situ (DCIS). DCIS is a condition in which a spectrum of abnormal cells are found in the breast duct and have not spread outside the duct to other tissues in the breast. While it is the most common non-invasive breast tumour, I quickly discoverd that it nevertheless presents unique challenges for patients and medical providers largely because the natural course of the untreated disease is not well understood. Because most women diagnosed with DCIS are treated, it is difficult to determine the comparative benefits of different treatment strategies versus active surveillance, meaning systematic followup.

So I am interested today to read that an independent panel convened by the National Institutes of Health (NIH) has urged the scientific community to identify appropriate biomarkers and other prognostic factors to better predict the risk of developing breast cancer.

“Instead of treating all women diagnosed with DCIS, we need to determine which individuals are likely to develop invasive breast cancer and which will not,” said Dr. Carmen Allegra, panel chair and Chief of Hematology and Oncology at the University of Florida. “If we could accurately predict this, we might save some women from undergoing unnecessary invasive treatments while achieving the same positive outcomes.”

Despite the connotations associated with the term carcinoma, DCIS is associated with ten-year survival rates close to 100% when treated with currently available therapies. These include breast-conserving surgery (local excision, with or without radiation), removal of the breast (mastectomy), and/or tamoxifen. It is important to stress that each of these treatment options has physical and emotional impacts to patients and should be weighed accordingly. The panel recognized that there are relatively few reliable data on the comparative effectiveness of both diagnostic and therapeutic options in DCIS.

The panel emphasized the importance of patient preferences and recommended improved communication between patients and providers, and serious consideration of new nomenclature that more closely reflects the excellent survival rates for this condition.

Efforts to improve communication would also include further development of formal decision aids. Such tools would reduce misinformation and improve understanding of a DCIS diagnosis and the risks and benefits of various treatment options. Individuals who have DCIS should have access to the best possible information and guidance to aid them in making care decisions that reflect their unique circumstances, perspectives, and preferences.

This is so important in my opinion. I was left trying to make decisions in an information and support vacuum, knowing that the treatment decisions I made would impact my furture quality of life, especially in relation to fertility. I listened to my medical team, took their advice, and underwent all the surgical,  chemotherapeutic and radiotherapy options they recommended at the time. Afterwards I questioned some of these decisions, as I struggled to come to terms with the impact they had on my fertility. Today I no longer torture myself with questions about whether I made the right decisions at the time or not. I am alive and I am grateful to have this second chance.  In the future, I hope this kind of new research and recommendations will make those decision easier on other women diagnosed with DCIS.  I am sure it will.

Source: NIH/National Institutes of Health, Office of Disease Prevention