The media are consumed with frightening medical issues – the most recent being breast cancer.
Some articles are well-written and balanced. Some are more hype than substance. What is the current medical understanding on breast cancer – and what do we not yet know?
Fact #1: The mammograms and biopsies and various cancer therapies have saved lives in the past and continue to do so today. However, not every breast cancer patient needs every aggressive treatment. Some need only to be watched closely.
Fact #2: Like most things in life, breast cancer is not just one disease with one treatment. Like all cancers, there are various stages of breast cancer – from not likely to grow or metastasize for decades (if ever) – to – likely to kill in the next twelve months. Unfortunately, only one word – cancer – describes them all. This leads to fear and confusion, causing the patient – and sometimes the medical professional – to opt for aggressive therapies in relatively mild cases in which there is no proof that intervention improves outcomes or changes mortality rates.
Fact #3: Ductal carcinoma in situ (DCIS) – Stage 0, non-invasive and unlikely to metastasize – is the breast cancer causing the most controversy. Increased mammography use has discovered this low level breast cancer in much higher numbers than previously suspected. In 20-34 year olds, DCIS can mean a high likelihood of future trouble, necessitating genetic testing and probable further surgery. In older women, DCIS may mean that this cancer only needs active surveillance.
Fact #4: Except for patients who have known risk factors (genetic predisposition, family history, previous breast cancer), no one knows which category most patients with DCIS fall into – to actively watch or to aggressively intervene. The various cancer agencies and various cancer experts disagree on how to proceed – because the studies have not yet been done to say for sure which DCIS can be watched and which ones must be pursued.
Breast cancer in women – especially DCIS – is in the same situation as prostate cancer in men: 1) we know that many small cancers will cause little or no problem in the future, 2) we know that past treatments have been too aggressive and sometimes harmful, but 3) we know that to do nothing will miss some whose lives could be saved.
Do we stop testing? No, only the unnecessary ones. Do we stop treatments? No, not for those who need them. But who should be tested and who needs the treatments for DCIS? At this point in our medical knowledge, no one knows for sure. And everyone is being cautious.
If you receive this diagnosis, talk to several qualified people. Know your personal risks. Consider your treatment options and their foreseeable consequences in concert with your personally-engaged health care professional. Consider lifestyle changes that can materially assist your treatment plan and affect your outcome.
Even with invasive cancer, don’t to rush to judgment. Think it through, then act.
