By Carol Parks, Contributing Editor
Imagine… you go in for your regular mammogram and are assured — happily — that you do not have breast cancer.
But — your doctor claims — you do have a kind of cancer referred to as ductal carcinoma in situ (DCIS)… also called “stage zero” cancer. Which means irregular cells are lodged in one or more of your breast ducts — the “highways” connecting the milk-producing lobes to your nipples. But they have not escaped to invade the other breast tissue. Yet.
Will they ever? Maybe… maybe not. Read on…
Continued below. . .
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Being diagnosed with DCIS is complicated, annoying… and horribly frightening.
On the one hand, you’re told not to fret; you don’t have invasive cancer and most probably won’t (the 10-year survival rate is 99 percent).
Then again, you’re informed you must have the cells surgically removed, along with, in some instances, radiation and chemo… pretty much the same as if you had full-blown cancer.
Though DCIS is almost always treated, scientists agree that not all cases of DCIS will turn harmful. In fact, most won’t. The words “in situ” literally mean “in place” — in other words, non-invasive.
DCIS comprises 30 percent of all breast cancer diagnoses, and is 99% curable. Breast cancer stages range from 0 to IV. The higher the stage, the worse the cancer… making stage zero seem pretty harmless.
So why all the hype — and the aggressive treatment? Is it all a hoax?
It all begins with a mammogram
DCIS is initially detected through mammography. But the trouble is, mammography is a very poor, inaccurate diagnostic tool.
Perhaps its most glaring problem is its unacceptably high rate of false positives, up to six percent. A false positive occurs when the test mistakenly indicates cancer is present.
It should be noted that we here at Cancer Defeated suggest you avoid mammography and use thermography, which has better detection for all stages of breast cancer without the risks of spreading potential cancers via compression and radiation. Detailed information about thermography is available in our Special Report, Breast Cancer Cover-Up.
Getting back to conventional testing, if a mammogram detects an abnormal spot, the next step is usually biopsy — cutting a small amount of tissue from the breast to be examined under a microscope by a pathologist to see if cancer is present.
A 30-year history of confusion, differences of opinion,
and unnecessary treatment
There’s a huge problem with conventional testing…
An estimated 17 percent of DCIS cases found through needle biopsy are misdiagnosed.1
Far from being the infallible “gold standard” claimed by conventional medicine… biopsy is fraught with errors and differences of opinion.
DCIS is notoriously tricky to diagnose, prone to outright mistakes and case by case disagreements over whether a cluster of cells is benign or malignant.2 Discerning these kinds of minute differences is a challenging area of pathology, the science of examining tissue samples for evidence of disease.
Plus, pathologists vary widely in level of experience and expertise. Some read as few as 50 breast biopsies per year — far less than the acknowledged 250 a biologist needs to perform before you can have confidence in his or her ability.
Add that to the fact that no diagnostic standards exist for DCIS, nor do any requirements of expertise levels in the pathologists who read them, and you have a real quagmire.
So maybe this statement by Dr. Shahla Masood, head of pathology at the University of Florida College of Medicine in Jacksonville is not so shocking…
He told the New York Times, “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”3
Indeed, even where your pathology report is done can affect the diagnosis.
Many of the hundreds of thousands of biopsies performed each year are done in small community hospitals, where the pathologist may only read a few breast biopsies a year. Thus, they lack exposure to atypical breast lesions. The local pathologist might not even be board certified.
In larger hospitals, the diagnosis may be decided by a tumor board.
Beyond diagnostic errors, there’s a difference of opinion as to what even constitutes DCIS.
Dr. Lagios, a San Francisco pathologist who reviews slides for second opinions, uses a criterion that does not classify some breast lesions smaller than 2 mm as DCIS, even if they possess other markers of it.
On the other hand, at Beth Israel Deaconess Medical Center in Boston — also a respected center for breast pathology — those same lesions are considered DCIS.4
“We have troubling news to tell you…”
In 2006, the Susan G. Komen for the Cure cancer group released a disturbing study.
In it, an estimated 90,000 cases of women who’d received a DCIS or invasive breast cancer diagnosis either (1) did not have the disease, or (2) their pathologist made another error resulting in incorrect treatment.
This wasn’t really a shock to the medical community, since this problem had been cited in the medical literature numerous times.
Take the illustrative stories of the women in the July 19, 2010 New York Times story as a case in point…
All of them began their troubling journey with mammography showing a spot… which led to biopsy… and a (mis)diagnosis of DCIS… which then progressed to painful, debilitating, and disfiguring breast surgery… and one even led to radiation therapy — only to be told later that they never had cancer at all.
Now imagine you’ve gone through that hellish series of events — and lived with the terrifying fear of invasive breast cancer — only to receive the troubling news that all the fear and pain was for nothing.
Not very reassuring, even though…
You’ve got plenty of company
An estimated one million women will be living with a DCIS diagnosis by 2020… and 50,000 new cases are diagnosed every year, just in the U.S.
DCIS incidence rose from 1.87 per 100,000 in 1973-75, to a staggering 32.5 per 100,000 in 2004. A more than seventeen times increase… according to a published report by Beth Vernig, PhD and colleagues, in the January 13, 2010 online issue of the Journal of the National Cancer Institute. Dr. Virnig is professor of public health at the University of Minnesota, School of Public Health.
Of course, that doesn’t mean there’s a sudden increase in this illness, or pre-illness, or whatever it is. It just means that testing has led to a massive increase in the number of cases diagnosed. Mammography may be responsible for the dramatic increase. Before widespread mammography use began in the 1980s, DCIS was rare. Now, since we assume early detection is the best way to “cure” cancer, we actively go looking for it.
In addition to finding cancer in earlier stages, doctors sometimes find cells in a twilight zone between normal breast cells and cancerous ones — a condition known as DCIS or “stage zero” cancer.
The standard treatment protocol
With few exceptions (notably elderly women with other health issues), standard practice is to treat DCIS as cancer, rather than monitor it to see if it progresses over time.
This means doctors are surely over-treating some (perhaps many) patients. Conventional medicine claims to lack the necessary tools to identify who should be treated and who should be watched. They may have a point, but…
With a DCIS diagnosis, your current treatment is almost always surgery — either a lumpectomy or mastectomy, depending on how widespread the cells appear to be in the ducts. As Allegra says, “it’s hard to imagine not doing any surgery.”5 (Emphasis mine.)
If the cells are concentrated in one location, you’ll get a lumpectomy followed by radiation… which conventional medicine says slashes the risk of recurrence in that breast (but not the other one) by half. But if abnormal cells are fairly widespread, they’ll typically advise a mastectomy and skip the post-op radiation.
Some women, particularly young women with a family history of breast cancer or genetic mutation (placing them at higher risk) even opt for a double mastectomy.
The rate of double mastectomies for DCIS patients skyrocketed from 4.1 percent in 1998 to 13.5 percent in 2005 — well more than a three-fold increase — according to a study published in April 2009 in the Journal of Clinical Oncology.
Your doctor may sometimes recommend Tamoxifen (a chemotherapy drug) along with surgery.
So, what if YOU get a DCIS diagnosis?
First, take a deep breath and realize that mistakes are regularly made. There’s no need to panic.
If you’re diagnosed with DCIS or any type of early stage breast cancer, ALWAYS get a second — if not a third and fourth — opinion. False positive rates are so high, the diagnostic criteria so subjective, and the risks of surgery, radiation, and chemo too great to forgo this step.
Before you make any treatment decisions, have your biopsy results reviewed specifically by a breast specialist.
As mentioned above, there are pathologists who specialize in rendering second opinions. I would certainly be willing to pay for it out of my own pocket, if necessary, before rushing into conventional medicine’s slice and burn protocol.
Some doctors are increasingly urging the cautionary principle even with a clear DCIS diagnosis. A wait and see attitude. There seems to be a growing body of evidence suggesting that some breast cancers may spontaneously regress without treatment.6
Certainly a “wait and see” stance gives you a heads-up and an opportunity to engage in some of the strategies we discuss here and in our publications.
The controversy about over-treatment
Lawsuits from women who have been wrongly diagnosed — and undergone radical disfiguring surgeries as a result — may be affecting the treatment landscape and giving credence to a less aggressive approach.
Conventional medicine is quick to rush you into surgery. But researchers at the University of California-San Francisco see DCIS as part of a larger problem of cancer over-treatment.
Laura Esserman, director of the Carol Franc Buck Cancer Center and Professor of Surgery and Radiology, co-authored the ‘controversial’ analysis in the Journal of the American Medical Association in 2009… which calls for a new look at screening for both breast and prostate cancer.
Her argument: Mammography catches more early cancers, but the number caught at more advanced stages has not declined at a similar rate — which you’d expect if they were simply identifying early cases before they progress.
So screening may just be finding cases that don’t need treatment.
What if we took the carcinoma out of ductal
carcinoma in situ — DCIS –and eased up on treatments?
There’s growing pressure in the medical community for dropping the “carcinoma” from DCIS — saying it is troubling and misleading (which is impossible to disagree with).
These same proponents also suggest DCIS as an excellent candidate for “active surveillance” — a watching-waiting strategy that skips surgery and radiation unless the condition progresses to higher risk.
So far, most of the drive for active surveillance seems to be coming from UC-San Francisco. Dr. Esserman has been especially forthright in demanding change in the naming and management of minimal risk cancers including DCIS.7
She advocates that minimal risk lesions should not be called cancer, and proposed a new term… saying the new name encourages a search for good outcomes without over-treating a rather benign condition.
With DCIS, “the bulk of what we find is not high grade… less than five percent of DCIS turns out to be ‘something else’ including invasive cancer,” explained Dr. Esserman to Medscape Oncology in an interview.
Only high-grade DCIS tends to progress to invasive breast cancer. “If if doesn’t look like high-grade DCIS, we should leave it alone. We would eliminate two-thirds of all biopsies if we did,” says Dr. Esserman.
She states that there’s sufficient data to rethink our entire approach to DCIS.
I’m sure eliminating two-thirds of all biopsies and practicing active surveillance will rattle those whose livelihoods depend on it. But that’s exactly the route I’d choose.
The American Cancer Society recently reported a sharp decline in our risk of getting cancer. But are their stats on the level? Ummm, not quite. If you missed this story in the last issue, scroll down and check it out now.
The Numbers Show a Cancer Death Decline …
But There’s More to the Story
The number of people dying from cancer has dropped drastically, at least according to new reports from the American Cancer Society.
Their numbers show a drop in mortality rates by 23 percent for men and 15 percent for women as compared with numbers 20 years ago. Overall, death rates have fallen for the four most common cancers: lung, colon, breast, and prostate.
Rates refer to number of cancer deaths per thousand people. If 10 people per thousand were dying from the disease in 1990 and 8 people per thousand were dying in 2010, the decline from 10 to 8 would be a 20 percent decline.
Continued below. . .
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More specific reports show death rates from cancer went down by 1.8 percent (i.e. per hundred people) for men and 1.6 percent for women between 2004 and 2008. Data for the reports comes from the National Cancer Institute and the U.S. Centers for Disease Control and Prevention.
The research also shows annual death rates for two minority groups — black men and Hispanic men — dropped most dramatically, at 2.4 percent and 2.3 percent, respectively.
Childhood cancer rates have also improved, with the five-year survival rate up to 83 percent (it was only 58 percent in the mid-1970s). From what I can learn, this is because of great success at treating leukemia, the most common type of childhood cancer. But please note that the percentage of children getting leukemia is actually going up. We’re fortunate this disease is now treatable.
Overall, cancer is the #2 cause of death among children above the age of one, only exceeded by accidents. This is a tragic fact. My guess is it’s due to the massive proliferation of untested chemicals and our unhealthy diets.
But having said all this, I put little faith in the official count of who died from cancer and who didn’t. Generally, cancer patients die of an infection such as pneumonia, or of heart failure — brought on by multiple rounds of chemotherapy that shatter the immune system, exhaust the patients, and leave them vulnerable to death from some cause other than cancer. Doctors don’t count these deaths as cancer fatalities. So the statistics for cancer deaths are essentially meaningless.
Why the decline in officially-measured cancer death rates? The American Cancer Society attributes the improved numbers to early detection and treatment.
Yet, this can’t be the whole story. After all, prostate cancer screening is no longer even recommended. According to the U.S. Preventative Services Task Force (USPSTF), prostate cancer screening provided no reduction in mortality.
We should also note that less common cancers are actually on the rise. These include cancers of the pancreas, liver, kidney, esophagus, thyroid, and skin. Experts don’t know the reason for the increase, but a few point their fingers at the obesity epidemic.
“More than a million deaths averted”
That’s according to Dr. Ahmedin Jemal, coauthor of the study that shows a decline in cancer. He was the first to cite early detection and treatment as an explanation for the reduction in deaths. He also cited improvements in cancer prevention, but at the same time pointed out that cancer deaths overall are bound to go up because of our aging, ever-growing population.
Jemal went on to say the best way to overcome these disparities is to expand medical centers, put more doctors in place, and energize the health sector. That way, the medical professionals can apply what they know to all segments of the population.
At the same time, Jemal — and most of mainstream medicine, like him — seems more focused on treating the symptoms of cancer on a massive level … instead of actively working to stop cancer from starting in the first place.
The problem with cancer statistics
Most people read cancer statistics and assume cancer is evenly spread throughout a population. But that’s not true. Look at breast cancer in England and Wales. According to a report from several years ago, breast cancer in women over 45 who lived in Leicestershire was 20% higher than the national average. Yet, in Cumberland it was 20% lower than the average. Oddly, Cumberland women were 50% more likely than average to have malignant melanomas, yet nearby in Durham, incidence was 30% below average.
How do you account for all the variation? It’s pretty simple. It’s practically positive proof that cancer extends far beyond genes into diet, lifestyle, and environmental factors.
Wouldn’t you agree then, that interventions should be more focused on these areas than in adding more medical centers to the world?
The problem with cancer statistics is that they get everybody excited about facts that may not matter in the grand scheme of things. You see, there are a number of ways to parse the numbers, and mainstream medicine tends to cook the figures to make itself look good.
I can easily believe the absolute number of lung cancer deaths is down because of the decline in smoking. Deaths from breast cancer went down massively when women found out hormone replacement therapy was a dangerous treatment, and stopped doing it. The reduction in new breast cancer cases was swift and drastic following this discovery.
And I do know colonoscopy screening is touted as a great success and doctors are catching a huge number of colon polyps before they become tumors.
The survival rate is even pretty good for more developed cases of colon cancer, those where a portion of the colon has to be removed by surgery. But I also have to tell you that life can be unpleasant following the operation.
When it comes to prostate cancer, I’d be suspicious that there’s been any real progress. Aggressive screening has led to the discovery of a great many more prostate tumors than in the old days, but most of those tumors would have remained undiscovered (and harmless — part of the reason these screenings are going out of vogue). The old saying is “Most men die WITH prostate cancer, not OF it.”
If a man over 65 has a small prostate tumor, chances are pretty good he’ll die years later of some other cause. 30 years ago those little tumors weren’t even diagnosed. Nowadays they’re found, treated (usually over-treated) and the medical statisticians claim they’ve “saved a life.”
For early-stage prostate cancer, total removal of the prostate is said to be nearly 100% successful at preventing cancer death. But the quality of life is low following prostatectomy, and in my opinion most or all of these early-stage cancers can be cured by alternative treatments, without surgery.
The underlying problem here is that as cancer rates improve slightly, everybody gets excited about early detection and surgical or drug intervention but little progress is made at prevention. And of course nondrug, nonsurgical alternatives are largely ignored although they could really knock down cancer rates.
Your health is in your hands
The American Cancer Society itself admits that at least 25 percent of total cancer deaths can be prevented because they relate to lifestyle issues: tobacco use, being overweight, lack of exercise, and poor nutrition. I would guess even more could be prevented if we paid more attention to environment and cultural issues.
Cancer remains an extraordinary problem. In North America and Western Europe alone, it’s the equivalent of eight fully-loaded jumbo 747s crashing every day with no survivors. It’s only going to get worse because the population is aging, and the risk of cancer rises sharply with age.
Health officials and individuals at risk should focus more on why cancers develop in the first place. This means examining everything about the way we live, from the food we eat, to the sources of our food, to the government subsidies that promote certain foods over others. And instead of looking the other way, they should also focus more on toxins in our soil, chemicals in our homes, and all the cultural trends that promote sitting the whole day through and never getting off our hind ends.