When to let “sleeping lumps” lie

Yesterday, I met with two new female patients who both came to see me for the exact same problem. Typically, the patients I meet with on a day-to-day basis are all there for a different reason. But two in the same day with the same condition? Well, that just tells me there are a lot more where they came from. In fact, judging from the increasing number of these cases I treat each year, it’s become a noticeably prevalent issue in women’s health.

That’s why the choice to write about ductal carcinoma in situ (DCIS) today was an easy one, to say the least. It needs to be addressed — even if I only reach one of the millions of women who are currently facing some incredibly difficult decisions in the wake of this diagnosis. (And who are most likely being horribly overtreated, just like my two patients had been by previous doctors.)

Before we dive in, let’s back up for just a moment: DCIS is the presence of abnormal cells inside of a breast’s milk duct. And women diagnosed with DCIS currently receive treatment as if they had malignant breast cancer—despite the fact that this very early form of the disease isn’t invasive.

Why is it treated so aggressively? Because apparently, doctors can’t identify which cases are most likely to progress to a more dangerous form of cancer. Although I can’t imagine to whom this judgment call would be unclear. I was taught in medical school that DCIS was a benign condition, to leave it be, and monitor it accordingly.

Of course, that seems like a million years ago now — you know, in the days before Big Pharma ruled the medical profession.

According to Big Pharma — oops, I mean “mainstream medicine” — common sense just isn’t sufficient in this case. Because despite the fact that statistics dictate the most conservative approach, we simply don’t know which unlucky few patients might go on to develop invasive cancer.

So we use surgery, radiation, and hormones on everyone. In fact, one of my patients was coerced into a double mastectomy with reconstruction, alongside a discussion of chemo and hormonal therapy. All within just two days of a diagnosis doctors wouldn’t even bat an eyelash over years ago.

Which brings me to the study I want to talk about today…

These researchers wanted to identify patients who were at highest risk of recurrence, while investigating the risks and benefits of these now-standard therapies. And their findings point the way to a better way of dealing with DCIS in the future:

  • Among women with a positive hormonal status, more than half received hormonal therapy. But it had no significant effect on overall recurrence or survival rates.
  • After roughly 8 years of follow-up, only 25 percent of DCIS cases recurred.
  • Among these cases of local recurrence, just over 37 percent were in situ (meaning, they reoccurred in the same place), while nearly 63 percent were invasive (meaning the cancer spread to surrounding breast tissues).
  • Average time for local recurrence was seven years—roughly five for in situ, and eight years for invasive recurrence. (Overall rates of local recurrence were 3.4 percent at five years and 7.6 percent at ten years.)
  • Overall survival rates at five years were 5 percent and 97 percent at ten years. Those rates were even higher, over 99 percent at both five and ten years, for breast cancer specific survival.

As you see, the recurrence rates are pretty darn low and the survival rates are pretty high. So why all the aggressive treatment? As I’ve always said, American oncology relies heavily on the “cut, poison, burn” method.

The good news here is that there are a number of trials underway as I type this—in the UK and Europe, of course (where the medical field is refreshingly progressive)—aimed at dialing back current DCIS treatment strategies. Including one comparing surgery to observation in low-risk patient groups.

And let’s hope those results come in sooner rather than later. Because if nothing else, this latest study shows just how low DCIS recurrence rates are. Suggesting that any life-altering treatment decisions really should be made on an individualized, case-by-case basis.

A recommendation that, sadly, you can pretty much guarantee with fall on deaf ears in this country.

After all, this is the same sort of thing that happened routinely with men and prostate cancer up until a few years ago. But because the disease affected male patients, we put a stop to that madness and figured out other methodologies.

Until we start treating women’s health with the same care and respect, you can bet this issue won’t go away anytime soon.

Which is why I’ve spent the last few months working on putting together a comprehensive cancer prevention and reversal protocol—so that you know ALL your options when it comes to prevention, screening, and treatment. I’ll be sure to keep you posted on my progress—and you’ll be the first to know when this potentially life-saving program is ready. Stay tuned!