Doctors are signaling a radical change for women with breast cancer – thousands may soon be denied treatment at all
Thousands of women with a common form of breast cancer may not need treatment at all, scientists suggested today.
About a fifth of all breast cancers are a slow-growing form of the disease that resides in the milk ducts, known as ductal carcinoma in situ (DCIS).
According to current UK guidelines, treatment to tackle these early-stage cancers involves surgery followed by radiotherapy to kill any abnormal cells lurking in the breast tissue.
But US researchers, who have followed hundreds of women with DCIS, have found that this barrage of treatments makes little difference to whether the cancer progresses – or to survival.
The study compared the outcomes of women who received standard therapies with those who were offered a ‘watch and wait’ approach.
This meant they were monitored every six months using scans and physical examinations.
After two years, the group of women who did not receive treatment were at no greater risk of developing a more invasive form of cancer than those who did.
Experts said today that the ‘provocative’ findings could pave the way for a new protocol for women with DCIS, which could come into effect in just five years.
Ductal carcinoma in situ, or DCIS, is a slow-growing type of the disease that resides in the milk ducts and is routinely picked up by screening. Pictured: DCIS in breast tissue
Under current UK guidelines, treatment to tackle cancer at its early stages involves surgery, which can then be followed by radiotherapy to kill any abnormal cells lurking in the breast tissue.
Professor Eun-Sil Shelley Hwang, an expert in radiology at Duke University in North Carolina, who presented the study today at the San Antonio Breast Cancer Symposium, said there is ‘a growing body of evidence that not all DCIS is destined to progress’.
She added: ‘Current practice may result in the overtreatment of women whose tumors have a low risk of progression.
‘This can lead to chronic pain, altered body image, reduced quality of life and other side effects that may be avoidable.
‘If these results are replicated in further studies, I think they will change the way we exercise. I’m going to be optimistic and say this can happen within five years.”
DCIS affects around 4,800 Britons a year and is becoming increasingly common as it is easily diagnosed through breast examination.
It is sometimes called ‘pre-cancer’ because in a minority of cases it can develop into an invasive disease.
But doctors don’t know which DCIS cases will be dangerous and which won’t.
In Britain, women aged between 50 and 70 are offered a mammogram – a special form of X-ray taken to detect diseases at their earliest stages – every three years.
Symptoms of breast cancer to look out for include lumps and swellings, dimpling of the skin, color changes, discharge and rash or crusting around the nipple
In the study, researchers followed 673 patients with one of the most common types of DCIS cancer.
Just under two-thirds underwent monitoring instead of treatment, and the remainder underwent surgery with or without radiotherapy.
Women in the monitoring group could opt for surgery at any time, and it was given if the tumor showed signs of invasive progression.
Both groups might also choose to receive hormone therapy, which blocks hormones in the body that can help the cancer grow.
During a two-year follow-up, 8.7 percent of the treated group was diagnosed with invasive breast cancer.
This means that the cancer has spread from where it started in the same breast to surrounding normal tissue.
By comparison, this figure was 3.1 percent among the control group who had not undergone radiotherapy or surgery.
The study, which was published today in the journal JAMAResearch also showed that slightly more women in the active monitoring group (71.3 percent) opted for hormone treatment, compared to 65.5 percent in the standard group.
Checking your breasts should be part of your monthly routine so that you notice any unusual changes. Simply rub and feel from top to bottom, in semi-circles and in a circular motion around your breast tissue to identify any abnormalities
But among those who received endocrine therapy, the rate of invasive ipsilateral cancer was 7.15 percent in patients who received care according to current guidelines.
In the active monitoring branch this figure was 3.21 percent.
Professor Hwang said: ‘Omitting surgery is highly controversial, with both patients and healthcare providers fearing it could result in an unacceptably high number of patients developing invasive cancer.
‘The important point to make is that these are early results.
‘Although the results are provocative, I don’t think they will change at all in practice.
“For those patients who have already decided that they refuse to undergo surgery, we have come up with active monitoring that is safe.”
She also told the San Antonio Breast Cancer Symposium, “This was a select group of low-risk patients. We will first need follow-up studies in five and ten years.
‘The active monitoring group would have had similar results if they had undergone surgery.
‘The small size of the invasive cancers detected is a sign that we have not delayed diagnosis in a way that is harmful to patients.’
One in seven women in Britain will be diagnosed with breast cancer in their lifetime – around 56,000 per year – making it the most common form of cancer in Britain.
In the US the figure is about 300,000 per year. About 85 percent of women diagnosed with breast cancer survive more than five years.