Comments on: Are we finding too much breast cancer?

By: Lee Smith

Lee Smith — Mon, 19 Oct 2009 04:54:14 +0000

Even if the word carcenoma is removed, the NIH consensus statement also notes that
“Mastectomy and local excision with radiotherapy are both effective local therapeutic approaches in patients who have DCIS. A randomized controlled trial comparing mastectomy with local excision and radiation has not been done, but current data demonstrate that long-term survival is similar with either approach. Although survival rates are similar, there is a higher local recurrence risk for DCIS with local excision and radiation therapy (12%, half of whom have invasive cancer) than in patients who choose mastectomy (about 1%).” So the question isn’t whether to treat it but how and that becomes a personal decision — mastectomy and minimum chance of recurrence, no need for radiation or lumpectomy and radiation plus hormonal treatment and increased chance of recurrence (which can then be treated by mastectomy),

Incidentally, Dr. Morrow at MSKCC has just come out with a study showing women are being “scared” into mastectomy nor are they being mislead by their MDs.

Surgeon recommendations and receipt of mastectomy for treatment of breast cancer.

Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, Graff JJ, Katz SJ.

JAMA. 2009 Oct 14;302(14):1551-6.

PMID: 19826024 [PubMed - in process]

By: Lee Smith

Lee Smith — Sun, 18 Oct 2009 23:43:46 +0000

Seen it, been there. Hiding the fact that DCIS is (non invasive) cancer and potentially will become invasive is not the solution in my opinion. Check out the NCCN 2009 report on breast cancer. No knowing and not considering action is not a solution, IMHO.

By: MK

MK — Sun, 18 Oct 2009 16:17:56 +0000

Lee, you might want to look at the materials here http://consensus.nih.gov/2009/dcisstatement.htm to see what the experts in DCIS are saying. Two things stand out: first, the experts agree that medical research needs to find a way to identify those women who can go without surgery for DCIS and second, they suggest removing “carcinoma” from the name to reduce the anxiety that women experience upon a DCIS diagnosis.

By: Lee Smith

Lee Smith — Thu, 15 Oct 2009 03:48:30 +0000

I would add that the prostate cancer situation doesn’t seem all that different. However, i think that a stronger argument for active surveillance and monitoring can probably be made for those whose prostate biopsies show low grade cancer. There is probably more time to take action and more indications of when things are getting worse. However the anti PSA test arguments are the same as the anti mammogram arguments and often made by the same so called experts such as Dr. Welch.

By: Lee Smith

Lee Smith — Wed, 14 Oct 2009 23:12:37 +0000

MK: with all due respect you don’t know what you are talking about. Unfortunately I know and I hope you never have to know. Having been diagnosed with DCIS just about a year ago — I had a lot of decisions to make. The first decision of course was whether or not to accept that I had cancer, albeit stage 0 non invasive. Reading papers, seeing the charts and graphs, discussing, etc, left little doubt I had cancer (albeit non invasive at that point) and that there was a rather large likelihood that it could become invasive (although not in the majority of case, definitely in a substantial number of cases). Hence I decided to try to get cured rather than take the chance of metasticizing cancer. No one told me to have mastectomy — if anything they didn’t think it was a good idea. I had two partial mastectomies– i.e. lumpectomies but there is no lump in DCIS as it’s distributed within the ducts. The margins weren’t great and although the standard statement is that lumpectomy plus radiation plus hormonal treatment has the same mortality rate as mastectomy it is also clear that the reoccurrence rate is smallest with mx — since you have no breast. I consulted with 3 surgeons and two oncologists and one radiation therapist and no one told me to have a mastectomy. But guess what, I and many women in my situation chose a mastectomy to minimize the chances of recurrence and avoid radiation and chemical/hormonal. (Some even get a prophylactic mx — I chose not to). As I said it was my choice and it’s your choice by I believe it’s essential to uncover if you have it so that you know that you need to make a choice. Not knowing is a choice as well. Check out the hundreds of women discussing/describing what it is to have DCIS at
http://community.breastcancer.org/forum/68

By: MK

MK — Wed, 14 Oct 2009 16:39:04 +0000

Lee, I agree with you, but doctors do not give women a choice based on their specific indicators. Healthy women with no family history, good diets and regular exercise habits are told that they must have mastectomies for DCIS. If I know that I have DCIS, meaning a higher chance of breast cancer, I’ll stay off of junk food for the rest of my life, stop taking birth control pills, etc. Seems to me that the surgery plus reconstruction are more harmful than the DCIS, but doctors won’t concede that. If you know of such a doctor who will, please publicize the name.

By: Lee Smith

Lee Smith — Tue, 13 Oct 2009 23:48:18 +0000

Are more and more indolent breast and prostate cancers being uncovered by mammograms and PSA tests — undoubtedly. Are some folks jumpiing to treatment prematurely — no doubt. 1. Solution one — ignorance and not testing. Fight to save lives only once the cancer metasticizes

2. Learn about cancer, check the odds, get screened, learn about the state of your body, and weigh YOUR OWN odds based on existing data and YOUR specific indicators.

Its your choice. 2 is tougher UNLESS your cancer invades your body. ITS YOUR CHOICE. Ignorance may be bliss and a little knowledge may be dangerour ITS YOUR CHOICE.

By: MK

MK — Tue, 13 Oct 2009 23:29:39 +0000

Gosh I wish it were more politically correct to spread this word. I never knew that mammograms were controversial until I received a diagnosis of DCIS. Strangely, I don’t feel like some awful cancer has invaded my body, rather, I feel angry as all heck at the medical establishment that pushes screening and then neglects to tell us that some “cancers” may never become harmful at all. I want to scream every time I see a newspaper article re: breast cancer awareness that says something like “Mary found a lump three months after a normal mammogram. Therefore, everyone should get mammograms.” If you have ever taken a course in logic, you know that the above statement fails the final.

And here’s the other dirty little secret. Many stage 1 cancers can be successfully removed by a lumpectomy. With DCIS, however, the lower (less dangerous) the grade, the more likely it is to be spread out, therefore necessitating a mastectomy. That’s right, women get their breasts removed for something with a low probability of ever harming them. So are we finding too much cancer? I don’t know. Are we finding too many abnormalities that we are quick to call cancer? Absolutely.

By: Lee Smith

Lee Smith — Fri, 09 Oct 2009 22:33:41 +0000

The sad thing is that you guys apparently have no clue as to what its like when you learn that part of your body has betrayed you be it DCIS or prostate cancer. Check out the discussion groups. We hope you never have to join us but if you do you will realize the idiocy of these anti screening approaches.

http://community.breastcancer.org/forum/68

By: DB

DB — Sat, 19 Sep 2009 12:39:24 +0000

My point is that women should be fully informed as to the risks of mammograms.
I was never told that false positives are very common and so totally unprepared for what followed….
I now have the information I need to make an informed decision and I didn’t get it from my doctor.
We all take chances in life – screening has risks and choosing not to screen has risks…and that is why we need risk information.
We can then make a decision based on our risk profile and considering the risks of testing.
I think it is unwise to assume all screening is a good thing for all people.
I’d suggest anyone interested in the topic look at the research published by the Nordic Cochrane Institute.
I think having blind faith in these tests is very unwise.
Of course, we can’t make decisions for each other, the decision to screen or not is entirely up to the individual.

http://www.bmj.com/cgi/content/full/338/jan27_2/b86?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22Mammograms%22&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT