More than 60,000 American women are diagnosed with DCIS annually. For those unfamiliar with the term, and I was too until I was diagnosed with it in 1999, DCIS stands for Ductal Carcinoma In Situ, which is a growth of malignant cells inside the milk ducts of the breast. Some doctors call it a pre-cancer, while others say that it’s the earliest stage of cancer.
I don’t know for sure, but I imagine if you’re reading this article you personally or someone in your life has been diagnosed with DCIS and you’re wondering what kind of treatment is best, given that it’s labeled a pre-cancer or early stage cancer. Should you choose treatment that is as aggressive as that prescribed for aggressive cancers, or people with large tumors?
As I am not an oncologist, but a 10-year cancer survivor, I am not in a position to give you any advice. But your questions are ones the medical profession has been asking itself lately as well. Susan Reed, an obstetrician-gynecologist at Seattle’s Fred Hutchinson Cancer Research Center recently served on an expert panel on DCIS in September, 2009 at the National Institutes of Health. Reed was quoted as saying that the medical profession is asking women to make decisions that are crucial to their lives, without a lot of hard evidence.
Part of the reason for the uncertainty around DCIS is because the diagnosis is relatively new. Its incidence has grown seven-fold since the early ’70s, when doctors began using mammograms. These X-rays of the breast, which are the butt of thousands of jokes by the women who have to endure them, can find tumors that are too small to be felt by hand.
While doctors would like to spare those diagnosed with DCIS the pain of chemotherapy and radiation, oncologist Patricia Ganz, a professor at UCLA’s Jonsson Comprehensive Cancer Centre says that they don’t know enough yet about it to tell a harmless tumor from one that could turn lethal. As a result, they tend to treat all women the same, regardless of the tumor’s size.
Thirty years ago doctors, who before the advent of mammography had never seen such tiny tumors, assumed that they should treat them like the large, lethal masses they were used to finding. They recommended additional treatments over the years as studies showed that radiation and hormonal therapies further reduced the risk of relapse.
The results? The cure rate is now strikingly high. After 10 to 15 years, only about 10 per cent of women with “low-grade” lesions — the least aggressive kind — have relapses. And these relapses are usually curable. Ninety-six percent to 98% of women are alive 10 years later. While the results are impressive, the debate on whether or not the treatments are all needed are still being questioned.
As a patient or loved one or friend of someone recently diagnosed with DCIS, was does this all mean for you? Like all cancer patients, your treatment choices are yours to make and should be made after consulting with the best oncologist you can consult. And don’t be afraid to get a second opinion, if that’s an option available to you. After my diagnosis, I sent my mammography films to a doctor who was known to specialize in DCIS, as a way of assuaging my fear and confirming my treatment choice.
While some women might feel comfortable refusing surgery and monitoring the DCIS via mammograms to see what happens next, that might not be the best route for you. As in investing, we all have different risk profiles. Some tend to be conservative, while others are comfortable making choices that others consider high risk. The Internet makes getting educated before making your choices incredibly doable these days, just make sure to go to reliable sites.
How you decide to proceed given a DCIS diagnosis is a decision best made between you, the educated patient and your oncologist.
Kathy Santini is a 10-year cancer survivor who is a life, business and results coach and the owner of Arbutus Coaching, http://www.arbutuscoaching.com Kathy is the author of the e-book: Live Your Best Life Now! The Cancer Survivor’s Guide to Creating a Happy and Meaningful Life, holds workshops for cancer survivors across North America and is a popular guest on radio and news programs. Some of the things Kathy has done in living her happy and meaningful life after cancer include: doing humanitarian work in Sierra Leone, building a house, nursing her dying mother at home during the last week of her life, working in a war zone in Kabul, Afghanistan as an editor and creating a successful coaching business.
To view reviews of her book for cancer survivors or to purchase it, visit http://www.arbutuscoaching.com/products.php
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