Dr. Frank Talamantes, Ph.D.

lactogen@MOUSEPLACENTA.COM

Study challenges status

quo in breast cancer
treatment
Researchers found no benefit of surgery for non-invasive "stage zero" ductal
carcinoma

A new study of more than 100,000 women suggests that many

unnecessarily undergo surgery for Stage Zero breast cancer called
ductal carcinoma in situ.
While the findings reinforce a growing notion that current treatments
for this condition are overly aggressive, they also create an even more
frustrating gray area for patients and doctors trying to navigate a
diagnosis that affects about 60,000 American women each year.
The analysis, published Thursday in the journal JAMA Oncology by a
team of Toronto researchers, follows a stream of other research
questioning widely accepted standards of care for breast cancer. For
example, medical providers have changed their recommended schedules
for mammography screenings after scientists have increasingly
concluded that mammograms are not as accurate as once thought. In
addition, ever-shifting knowledge about how peoples diets and
environments affect cancer have added complexity to what used to be a
relatively clear-cut diagnosis and set of treatment regimens.

The latest paper indicates that a lumpectomy (removing part of a

breast), mastectomy (taking out the whole breast) or double mastectomy
(removing both breasts) after ductal carcinoma in situ, or DCIS, does
not increase a patients survival rate.
After examining records collected by the National Cancer Institute,
researchers found that, 20 years after diagnosis, the death rate was 3.3
percent for women with DCIS whether or not they had surgery.
African-American women and women 35 or younger at the time of
diagnosis had 20-year mortality rates that were more than twice as high
as older women and those from other ethnic backgrounds.
Ductal carcinoma in situ is so named because it is not invasive when
first detected in the milk ducts of the breast. In some women lesions
eventually invade other cells while there is no spread in others.
To date, the standard of care has been to remove DCIS tissue, even if
there is only a tiny bit present, rather than continuing to monitor the
cancer to see if it becomes invasive.
Dr. Anne Wallace, director of the Comprehensive Breast Cancer Health
Center Team at UC San Diegos Moores Cancer Center, said many in
oncology feel strongly that stage zero breast cancer is often over-treated.
But she, like many of her peers, said the JAMA study, because it simply
examined the health records of patients, rather than conducting a
double-blind clinical trial, is not by itself likely to change the current
standard of care.
I do think that this will launch a discussion at the scientific level. Its
going to give us the leverage we need to continue to have treatment
discussions with our patients, Wallace said, adding that several
University of California cancer centers are considering a more rigorous
study that could, some day, get at more definitive answers.

Dr. Christina Casteel, a breast cancer surgeon with Sharp HealthCare,

said a study that randomly assigns women treatment or watchful waiting
is needed to gain greater understanding.
I dont think were going to step outside what the current national
standards are until we have conclusive data from a randomized clinical
trial, Casteel said.
Still, both she and Wallace said the new JAMA study can help calm
women down about a cancer diagnosis that often causes significant
distress. After all, DCIS mortality rates were far below 10 percent, even
for women in demographic categories shown to be most at risk.
I think this can help to talk women off the cliff, Casteel said.
Wallace said she has already been taking a lighter approach with
patients who arrive in her office with a DCIS diagnosis.
I say to my patients take a deep breath, because, in a number of years,
we might not even be treating this, Wallace said.
That approach, she added, is not always popular.
Right now the politics of breast cancer are against that. Women have
been indoctrinated that cancer is going to kill them. I think that
conversation is in the process of changing, Wallace said.
Some are not waiting.
After three surgeries failed to fully eradicate her DCIS in 2010, Donna
Pinto of Rancho Peasquitos got to Googling and found studies that
indicated the disease might never spread.
That was enough. The certified nutritionist said she decided to further
modify her already-healthy lifestyle rather than undergo a mastectomy.

She said she has regular magnetic resonance imaging scans to make sure
the carcinoma has not become invasive. Five years later, she said, her
doctors have detected no change.
Since diagnosis, Pinto has become a voracious consumer of DCIS
research and discussion and said she pounced on Thursdays JAMA
study. It was, she said, a wonderful read.
I feel its validating everything Ive been studying over the last five
years. There have been studies in Europe that say this, but never
anything of this magnitude, she said.
The mother of two has not kept her diagnosis and subsequent treatment
decisions to herself. She created DCIS411.com a blog that documents her
treatment journey.
Casteel, the Sharp surgeon, said that patients who decide to forego
surgery should be aware that they are in uncharted territory. Because
the standard of care is to perform surgery, either a lumpectomy that
removes a small portion of the breast, or a mastectomy which takes the
whole organ, there is little knowledge about how quickly ductal
carcinoma in situ goes from noninvasive to invasive.
This is a very hotly-debated topic. Should DCIS be called cancer at all?
We just dont know the exact natural condition, Casteel said.
But, after reading the available literature herself, and consulting with
numerous oncologists, Pinto said she is convinced.
With all of the information I gathered, it made no logical sense to me to
lose my breast or subject myself to weeks of radiation treatment, she
said.
DCIS is far from the only area of breast cancer controversy.

Professional medical associations currently disagree with a 2009

recommendation that women should not get their first mammograms
until age 50, rather than 40, because the risk of false positives, and
unnecessary treatment, is greater in younger women.
Evidence also suggests, for example, that previous blanket prohibition of
soy protein for breast cancer patients may not be warranted.
And another large study in 2014, which examined the records of 90,000
women, found that women randomly-assigned to have mammograms
had breast cancer death rates that were the same as those who didnt.

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