Ductal carcinoma in situ (DCIS), also known as precancer or stage 0 breast cancer, usually doesn’t present much risk to women when diagnosed, but a new study has found that for certain women there is quite a risk: black women and those younger than 35.
Analyzing U.S. government data on more than 100,000 women diagnosed with DCIS from 1988 to 2011, researchers found the mortality rate 20 years after diagnosis to be just 3.3%. However, for women under age 35 and those who were black that number more than doubled to 7.8% and 7%, respectively.
Thanks to the standard use of mammography and other imaging techniques, DCIS has been diagnosed in more women in recent years, with the disease now accounting for 1 out of 4 diagnoses in the U.S. or 60,000 women per year. Because of the low danger the disease presents to most patients, some in the medical community have come to believe DCIS is both overdiagnosed and overtreated, with the minimum treatment being a lumpectomy and weeks of radiation (which, in this study, lowered risk for recurrence but didn’t increase 20-year survival), and often a mastectomy, sometimes even a double mastectomy, as a Pubic Library of Science (PLOS) blog pointed out. Given this newest data it might be time to shift that paradigm, as the study authors wrote: “It is often stated that DCIS is a preinvasive neoplastic lesion that is not lethal in itself. The results of the present study suggest that this interpretation should be revisited. Cases of DCIS have more in common with small invasive cancers than previously thought.”
Laura Newman at PatientPOV agrees. While she told PLOS “overdiagnosis can spell waste and harm,” like patients undergoing treatment procedures they don’t need, she also acknowledged that “an inadvertent casualty of the fight against overdiagnosis is that patients who do not fit that profile are overlooked.” In this case that would mean young women and black women.
While researchers have yet to understand exactly why these two populations are at increased risk, Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer, told The Huffington Post these findings shouldn’t cause women to panic. The important thing, he said, is for doctors to discuss rates of mortality and recurrence with patients and make sure they’re well-informed of all of their options.