Is DCIS Dangerous or Over-treated? How Can You Manage the Risks?

[@cathy7562]

You make some very good points. Overdiagnosis and overtreatment is becoming a huge issue. With the advent of more and more performant imaging techniques, the incidence of DCIS increased by 500%. At the same time, the incidence of invasive cancer still increased by 35%. If DCIS diagnosis and treatment would be efficient and lifesaving, then why don’t we see a reduction in the incidence of invasive cancer? Another point is that "previous biopsies" are considered risk factor for DCIS becoming invasive. Medical professionals are very quick to dismiss the reasonable concern many patients with micro calcifications who are pushed to do biopsies about the risk of seeding cancer cells outside ducts as a result of the procedure. It is common sense that biopsy causes strong local inflammation, bleeding, and dislocation of tumor cells into the bloodstream, which, without biopsy would stay inside ducts, eventually die inside the ducts, and turn into the microcalcifications seen in mammographies. So why not leave those tumor cells alone INSIDE the ducts? The justification is that they may break away and become invasive cancer who knows when, perhaps never in the lifespan of the patients. DCIS is known to evolve very slowly and many women die of old age WITH DCIS which never bothered them. But wouldn’t piercing of the ducts help those cells break away faster, leading to an urgency of subsequent surgery, radiation, chemo, with all the detrimental effects on the overall health, that will ultimately lead to shortening the patient’s life? Of course, going through all these procedures is also very costly and it is exactly what doctors want. To sum up, DCIS is stage 0 cancer, inside ducts. It does not metastasize. 10-50 % of women with microcalcificatios may, over decades, develop invasive cancer if DCIS is left untreated. However, clinical studies show that 54% of women who were treated for DCIS by lumpectomy developed tumor recurrence. So, the odds are better if DCIS is left alone, without all the deleterious effects on the human body from what seems to be unnecessary treatment.

[@JudyAiken]

Thank you for this. Even the website of the American Cancer Society lists having had a biopsy as a risk factor for breast cancer.

[@user-cy5ls9ge8w]

Did dcis come back after mastectomy

[@cathy7562]

@@user-cy5ls9ge8w DCIS would not come back after mastectomy because there would be no ducts if the breast is gone. Metastatic cancer may develop as a result of surgery itself. In my case, I did not let them do any biopsy 5 years ago when I was diagnosed with BI-RADS4 microcalcifications, much less a mastectomy. Their push to put me through biopsy was based on what they saw on my first mammogram ever: few specs of microcalcifications. They had no idea how long the microcalcifications have been there and they had nothing to compare to. I had no symptoms, I did my research, and chose the watchful waiting approach. As a molecular biologist, I have full understanding of the tissue and cell damage a biopsy can cause. Five years later, there is no change in my microcalcifications and I am officially negative of any suspicion. If I had listened to them 5 years ago, I would have been a cancer survivor now, part of statistics, with lots of damage in my body from radiation and chemo, or, who knows, I would have full blown cancer from the spread of malignant cells during biopsy. I strongly support good medical care and periodic checks, but the overdiagnosis of microcalcifications has gotten out of control. Do I likely have malignant cells in the ducts or lobes? It’s possible. We all have malignant cells at any time anywhere in the body, but the killer T cells take care of them. As long as they stay in situ, get killed and turned into microcalcifications, and don’t get seeded through unnecessary traumatizing procedures, I am OK. This is only my personal experience and choice; every individual is different, with different genetic and epigenetic predisposing factors, so not all DCIS suspicions or diagnoses are the same.

[@cathy7562]

@@JudyAiken Indeed, ACS, and many papers I read from NCBI, list biopsy as a risk factor. Sure, when there is very strong imagistic evidence of evolution, tissue distortions, lumps, biopsy becomes necessary. But biopsies for micro calcifications can do more harm than good. I shared my personal experience in a response below.

[@yerbba]

Thanks for writing and sharing your thoughts with the community. It is not the case that cells that are disturbed or dislodged will spread and cause recurrence in other parts of the body. The cells that do get disturbed are not "clonogenic." That is, they do not have the same ability as do metastatic cells to erode through the basement membrane from the tumor, spread through the body, erode through the basement membrane of the "receiving" organ, and establish themselves as distant tumors. There are some cancers that cause problems when biopsied, seeding the needle track. Most well-known for this to happen is with testicular cancer.

[@kathygann1180]

Thank you for this. Surgery and 4 1/2 weeks of radiation sure seems overkill for 2 cells of cancer. Two cells!

[@yerbba]

Thanks for writing. It's possible that there were only 2 cancer cells at the time of surgery, but in most cases, there are additional cells that radiation therapy can prevent from growing into larger tumors. We do skip radiation therapy in some people who had wide margins and ER-positive DCIS especially if they can take endocrine (hormonal) therapy. We're really in this case treating the remaining breast tissue of course.

[@traceymanzano4015]

When it comes to any cancer ,whether its pre-invasive or not, you can NEVER overkill! It's far better to be safe than sorry! If you dont do enough,and it cycles back more aggressive,then what? All the doctor can say to you is "I'm so sorry", while you then have to do many months of chemo and radiation at that point .I couldnt take that chance! I had a bilateral mastectomy. It was drastic,but I feel very at ease.

[@prettypuppy6752]

@@traceymanzano4015 well done in making that incredibly difficult decision. I have just been through the same confusing decision making process and decided to do a Bilateral mastectomy for exactly the reasons you cited. My surgery is next week and I’m very scared and anxious but I have high grade DCIS coursing through my right breast in a band in two separate sites so lumpectomy was not possible. Now I have decided to go bilateral like you did as I do not want an aggressive and invasive ductal cancer to develop in the left breast which already has epithelial hyperplasia in the ducts plus several fibroadenomas. It’s just NOT worth the risk. I pray that your surgery went well and you are fully recovered. Did you have a reconstruction?

[@traceymanzano4015]

@@prettypuppy6752 No,,I wear my prosthetic bras when I feel like it,but not every day.I enjoy the lightness I now have, without having breast.

[@ssrk369]

I had fibroadenama operation and in biopsy results after operation the tumor which was removed had cribriform dcis,the doctor said since the tumor is removed no need to worry and 3 months once consultation is required... but I have fear whether it'll spread to other

[@yerbba]

A small area of cribriform DCIS is unlikely to cause problems down the road with spreading or even recurrence in the breast. It may be worth asking about the benefit of radiation therapy in your case.

[@amymocan2666]

Hello, I'm 31 and diagnosed with DCIS HG the size of tumour 8CM , I've just had a mastectomy & reconstruction but waiting for the results. You mentioned in another that the biopsy isn't always the same results as the pathology. From your experience is this more likely to be a invasive cancer rather than dcis. Kindest regards and thank you for your video Amy x

[@yerbba]

Thanks for writing. With a larger area that is affected as in your situation, it is more likely than in a smaller tumor that there will be invasive cancer within the DCIS, but it is still within the realm of possibility that this is pure DCIS. Wishing you the best as you wait for your pathology report.

[@marciaart3563]

Thank you for your clear explanations.

[@yerbba]

Glad it was helpful!

[@BeingMeRV]

What are some other ways to treat it besides surgery, radiation and hormones?

[@yerbba]

There are some clinical trials looking at treating DCIS in novel ways that may be able to omit surgery, but none of these has yet been proven safe.

[@BeingMeRV]

@@yerbba can you share some of the novel ways or point me to the trials or researchers leading the trials?

[@Trendingvideos-yn4fj]

Hello, Diagnosed with dcis surgery, radiation completed now on hormonal theraphy, doctors prescribed zelondronic for every 6 months. could you please eloborate why zelondronic recommends while on tamoxifen. Age is 43

[@yerbba]

The bisphosphonates, such as zolendronate (also called zolendronic acid) are good for people with low bone mineral density. In people on tamoxifen who are premenopausal, the bone density can be decreased while you're on tamoxifen. For postmenopausal women, tamoxifen improves bone mineral density. It is uncommon to need zolendronic acid, but if there is evidence of very low bone mineral density, there may be a role for this medication.

[@cursorart5590]

​@@yerbbaok

[@dorianaaronson9602]

Hi, can you talk about LCIS with microinvasion. I was diagnosed recently and then after surgery was told I also have DCIS. Currently radiation therapy and hormone therapy is the plan moving forward once I completely heal from surgery. Thank you 😊

[@yerbba]

LCIS is a peculiar diagnosis because it sounds like it's cancer. However, we do remove LCIS to see if there is invasive cancer hidden within. It sounds like in your case that you have DCIS with microinvasion along with LCIS. That is, the LCIS is not the main diagnosis. Your treatment will be focused on treating the DCIS with microinvasion more than the LCIS. You are getting excellent care.

[@dorianaaronson9602]

@@yerbba Thank you, as of today I am putting radiation on hold until I get results back for the breast cancer marker. If positive I may have a bilateral mastectomy with reconstruction thus avoiding radiation.

[@okdk7]

A friend 40 year old female with stage 0. BRCA2 and ER+ ... Curious what current statistics and outcomes are for various options... Any news on this ?

[@yerbba]

Stage 0 cancer does not have the ability to spread to other parts of the body, so treatments such as chemotherapy and targeted therapy are not given. In someone with a BRCA mutation, there is a higher risk of cancer in the unaffected breast. For that reason, many people have a bilateral mastectomy but this is not absolutely necessary.

[@Onumero66699969]

Thanks 🙏🏼

[@yerbba]

Thank you for watching. We appreciate your support.

[@GLD-hopeful]

I am TERRIFIED of AI drugs which I am told I will need for 5 years after lumpectomy followed by radiation. I am 67 with biopsy identified stage 0, cell grade 3 DCIS (area is 1-2 cm) R breast (36 D). Lumpectomy is in one week but told the genetic testing results likely won't be returned until AFTER the surgery. I am not as afraid of surgery/radiation as I am the hormone drugs that will likely result in osteoporosis, arthritis and increased cholesterol (high already and unable to take statins). What is the risk if I do not take the hormone blocker if pathology after surgery doesn't change from that of biopsy? Had hysterectomy in my 30s for prolapse, but kept ovaries. THANK YOU!! Great videos. ❤️

[@yerbba]

DCIS is an interesting condition. Because endocrine therapy reduces only the risk of recurrence in the affected breast (and the other breast but to a lower extent) and does not improve survival, omitting endocrine therapy is one option. Tamoxifen, which improves bone density, is also something to discuss with your team.

[@vester7457]

I'm in the EXACT same position as you. I'm 65 and had the DCIS surgery 12/28/23. They want me to do 3-1/2 weeks of radiation in Feb 2024. I draw the line there. I'm not taking a drug that tampers with hormone levels. Whenever my common sense has been in conflict with medicine protocol, I follow my common sense. I have no health history other than this, take zero meds, low blood pressure etc. healthy as a horse. Not getting steamrolled

[@pchatterjee742]

I have fibroadenoma and ductal dilation in left breast... This was USG finding... Doctor still recommend mammogram to see if there is any connection between ductal dilation and fibroadenoma..

[@yerbba]

It’s good that your doctor is being thorough. While a fibroadenoma and ductal dilation are often benign findings, a mammogram can provide a more detailed view and help clarify if there’s any connection between the two. It’s an important step to ensure a comprehensive understanding of your breast health, and your doctor is likely just being cautious to rule out any underlying issues. Ultrasound and mammography can pick up different things and are often used together.

[@lauraglass1558]

Don’t all cancers start in situ? Meaning, if left alone, won’t it ultimately become invasive?

[@yerbba]

That's an insightful observation. While it's true that all cancers start at a cellular level, it is not entirely clear that all invasive cancers begin as in situ cancers. That is, cancers may spend very little time as non-invasive malignancies.

[@dm8553]

I have dcis stage 0 grade 3. What are your thoughts?

[@yerbba]

Thanks for writing. It is unlikely that we are over-treating grade 3 DCIS. Despite the grade, the prognosis is excellent with treatment.

[@dm8553]

@@yerbba my surgeon suggested a mastectomy for me because the calcifications are numerous and spread out in at least half of my breast. My lymph nodes are ok though. I think I'm more worried about the recovery than the cancer. I live alone and don't have anyone to help me.

[@ithacacomments4811]

Can cryoablation be used for DCIS?

[@yerbba]

Cryoablation is a promising approach for treatment of small tumors. The concerns are that not all the tumor can be detected before the procedure, but MRI is a big help. Cryoablation is not yet the standard of care, but it is certainly coming a long way.

[@nancybass1962]

The new research shows that estrogen does not cause breast cancer, so why do oncologists still prescribe aromatase inhibitors?

[@yerbba]

While estrogen technically does not cause breast cancer, blocking estrogen from getting to cancer cells with drugs like tamoxifen and reducing estrogen in the body markedly decreases the risk of recurrence in people with early stage breast cancer and can lead to a complete remission in people with metastatic disease. Anti-estrogen therapies are powerful treatments for breast cancer.

[@kathanzia]

Seem to be contradicting yourself. Treating aggressively because of fear not facts.

[@yerbba]

We of course apologize for any confusion. And because preferences play such a large role in treatment, there are a lot of contradictions in the treatment of any serious illness. People often write asking if they need a particular treatment. It's key to remember that no one is the same as another person.