Ductal Carcinoma In Situ - Is It Cancer Or Isn't It

October is Breast Cancer Awareness Month

How do we define cancer -- by its properties and characteristics which include abnormal, rapidly dividing cells which invade into surrounding and distal tissue. Dissemination and disruption of normal bodily functions are the sequelae of cancer.

Ductal Carcinoma In Situ (DCIS) is an aggregation of abnormal cells within a breast duct(s) which does NOT invade into surrounding or distal tissue. As such, it has been considered as a "pre-cancer" or precursor to invasive breast cancer. It is graded as low, intermediate or high risk DCIS referring to its likelihood of developing into invasive breast cancer. Treatment options for this " not yet" invasive cancer have ranged from observation, lumpectomy, lumpectomy with radiation, lumpectomy with hormonal therapy to mastectomy. Recent studies have suggested a conservative approach for women with low grade DCIS. It has become confusing and overwhelming for women considering various treatment options.

In February 2016, the New England Journal of Medicine (NEJM) presented a case vignette of a 54 yr old otherwise healthy woman with newly diagnosed low grade DCIS. The journal polled its readers as to whether they would recommend watchful waiting with close observation or lumpectomy with/without radiation.

There were 545 respondents with 81% choosing lumpectomy. Many voiced concern that additional studies and data were needed to appropriately assess the various treatment options and to adequately advise patients. This sentiment was recently echoed by Vinod who believes that the use of technology to assess and correlate massive amounts of data and trends will help to make medicine and medical treatments less subjective and more evidence based in the future.

For all of us women, let's hope he's right.

Sharan Abdul-Rahman, MD

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