For the final day of Breast Cancer Awareness Month, I want to put the spotlight on one breast cancer issue that doesn’t get nearly enough attention.
I’m talking about breast cancer overdiagnosis and overtreatment—topics most doctors would rather not talk about at all.
The fact is, thousands upon thousands of women are unnecessarily treated with aggressive measures for a relatively benign condition known as ductal carcinoma in situ, or DCIS.
DCIS is a red flag that all women need to be aware of so they can avoid the fear, anxiety, physical pain, inconvenience, and expense of treatments that, in most cases, they don’t even need.
Is ultra-low risk cancer really cancer?
Ironically, modern science has created advances in cancer screening technology. And sometimes, the screening tools are so sensitive, they detect abnormalities that could potentially escalate into cancer… but likely never will.
That’s the heart of the problem with DCIS.
In fact, one breast cancer oncologist— Laura Esserman, M.D. of the University of California San Francisco—has suggested that we reclassify ultra-low-risk conditions like DCIS so that they’re less likely to be treated aggressively.
Writing in the British Medical Journal (BMJ), she notes that DCIS consists of abnormal cells in breast ducts, but it’s rarely lethal. And yet, doctors remove DCIS from 60,000 to 70,000 women in the U.S. every year.
In Dr. Esserman’s view, DCIS should be classified as a risk factor rather than a disease, in hopes that many thousands of women could avoid unnecessary procedures.
I believe Dr. Marc Micozzi would agree wholeheartedly with that approach.
In his Authentic Anti-Cancer Protocol, he notes that DCIS is part of an “epidemic of over-diagnosis and overtreatment of cancer.”
And he adds that this excessive medical response to a risk that barely qualifies as cancer creates unnecessary costs, confusion, and worry: “Not to mention very real, very negative side effects from unnecessary treatments.”
The “medical emergency” myth
The American Cancer Society reports that in 2015, almost 20 percent of all new “cancer” cases in the U.S. were DCIS.
Put another way: Nearly 1 in 5 women who were told they had breast cancer may have been unnecessarily treated.
Dr. Micozzi notes that too many conventional oncologists see DCIS as the earliest sign of breast cancer, so they typically treat it as a medical emergency. Oncologists generally order a lumpectomy within two weeks after diagnosis, followed by radiation.
Unfortunately, mainstream cancer organizations promote the myth that aggressive treatment of DCIS saves thousands of lives—even though the hard numbers don’t quite support this claim.
In a new study that included more than 100,000 women, researchers found that DCIS was linked with only a 3.3 percent rate of breast cancer deaths over a 20-year period.
Dr. Micozzi puts that number in perspective: “That’s similar to what the American Cancer Society cites as the risk of an average woman dying of breast cancer. In other words, you’re no more likely to die of breast cancer if you’re diagnosed with DCIS than someone without this diagnosis.
“And considering a five-year survival rate is the typical benchmark for success in treating cancer, DCIS hardly qualifies as the medical emergency so many clinicians treat it as.”
Three subsets of higher risk
Dr. Micozzi stresses that surgery and radiation are necessary sometimes, but for only a very small number of DCIS cases.
For instance, the study I mentioned a moment ago shows that women under the age of 35 diagnosed with DCIS have a breast cancer death rate of 7.8 percent. This isn’t surprising, Dr. Micozzi says, because young women typically have more aggressive forms of cancer growth compared to older women.
In addition, the researchers found that African-American women with DCIS also had a higher mortality rate of 7 percent.
Dr. Micozzi also notes that careful assessment of breast cancer tissue cells in DCIS is necessary. The size of the cells, their appearance, and their response to estrogen determine the grade. “Women with higher-grade DCIS cells,” he says, “were 1.9 times more likely to die compared to women with lower-grade cells.”
In the end, just 20 percent of women with DCIS had one or more of these characteristics that put them at risk of eventually developing true breast cancer. But researchers said that these were the only women who probably should have lumpectomies and radiation.
For the others—a full 80 percent of the women diagnosed with DCIS—Dr. Micozzi says there’s no harm in “watchful waiting” and following the natural cancer-preventive measures he details throughout his Authentic Anti-Cancer Protocol.
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“Should we rename low risk cancers?” BMJ 2019; 364: k4699. doi.org/10.1136/bmj.k4699