Noninvasive breast disease divides cancer experts
By Luis Fábregas
Published: Saturday, Oct. 12, 2013, 9:00 p.m.
An increasingly common type of noninvasive breast cancer is sparking debate about whether it should be called cancer at all.
Some in the medical community say the disease — called ductal carcinoma in situ, or DCIS — should not be called cancer because it's not malignant and doesn't spread to other parts of the body.
Breast cancer experts at Allegheny Health Network say DCIS, the presence of abnormal cells in the milk duct, is “more than a minor medical nuisance” that can increase the risk of developing malignant breast cancer.
“The disease is real,” said Dr. Lawrence Wickerham, director of the division of cancer genetics at Allegheny General Hospital. “Simply changing the name is not going to change the biological nature of DCIS.”
Wickerham and colleague Dr. Thomas Julian, associate director of AGH's breast care center, wrote about the issue in the Journal of the National Cancer Institute.
In the same edition of the journal, experts from Dana-Farber Cancer Institute in Boston argue that DCIS should not be called cancer because it does not spread beyond the milk duct into normal surrounding breast tissue.
DCIS once represented less than 5 percent of new breast cancer cases but now accounts for up to 25 percent of new cases, doctors said. About 64,640 cases will be diagnosed nationwide this year. Doctors attribute the increase to more women undergoing mammograms each year.
That's the way Lisa Paschall of Cranberry found out in February that she had DCIS.
“It stops your life right there,” said Paschall, 46, who was under the care of Julian at AGH.
Paschall, a stay-at-home mom of three boys, underwent a lumpectomy, followed by radiation. She is now taking tamoxifen, a drug used to block the effects of estrogen.
“To me, I consider it a cancer,” she said, supporting the belief of her doctors that its name should not be changed. “I knew it was not going to take my life. But it doesn't mean down the road that I'm safe.”
Misconceptions about the severity of illness can crop up because patients with DCIS go to the same cancer centers where patients with invasive cancers get treatment. There doctors tend to offer a range of treatment options, said Dr. Rinaa S. Punglia, assistant professor of radiation oncology at Harvard Medical School. As a result, patients run the risk of being overtreated and tend to overestimate the risk of the cancer's spreading, she said.
“We need to be better about how we present DCIS to patients so that their treatments are aligned with what their actual risks and preferences are, instead of scaring women into getting certain treatments, or thinking there's just one right way to treat DCIS,” Punglia said.
Dr. Kandace McGuire, a breast surgical oncologist at Magee-Womens Hospital of UPMC, said she had several patients with DCIS whose primary care doctors told them that they did not have cancer. This confused some women because they were given a range of treatment options, ranging from hormone therapy to a mastectomy, she said.
“We have to go to square one and talk about how, although it's not an invasive cancer, there are these cells that if left unchecked have probably a 40 percent chance of progressing into an invasive cancer,” said McGuire, an assistant professor of surgery at the University of Pittsburgh School of Medicine. “A change in terminology may make the general public feel like this is not a big problem.”
Regardless of what it's called, Wickerham said, patients need to be followed carefully because no one can predict whose DCIS will be aggressive and which patients will wind up developing invasive cancer.
“We're getting better at that, but we're not perfect at it,” he said. “What I don't want to occur is, because of publicity and discussion, for women to think that they're being mistreated in some way or that they should avoid mammograms because of this potential dilemma. That would not serve anyone well.”
Luis Fábregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or firstname.lastname@example.org.
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