What to do about the non-invasive breast lesions called ductal carcinoma in situ, or "stage zero" cancer, is one of the hottest debates in breast cancer care.
Because of more widespread screening, more and more women are being diagnosed with DCIS. The condition now makes up 20 percent of new breast cancer cases, according to the American Cancer Society.
DCIS doesn't always progress to invasive breast cancer, which is the life-threatening kind. In fact, some physicians and researchers, including a working group convened by the National Cancer Institute, say it's not accurate to call DCIS a form of cancer at all, and that the terminology is contributing to overly aggressive treatment.
"We are certainly overtreating this disease, but we haven't figured out who can get less treatment, no treatment or active surveillance," says Mehra Golshan, a breast surgeon at Brigham and Women's Hospital in Boston. Surgery (lumpectomy and in some cases mastectomy) is the standard of care, but a study by Golshan and his colleagues may support some women's decision to skip the surgery, which comes with physical, emotional and financial costs.
The study, published Wednesday in JAMA Surgery, relied on a National Cancer Institute registry covering 57,222 cases of DCIS in women treated in nine U.S. states between 1988 and 2011. The researchers looked at what happened to women who had surgery and to the small minority of those who didn't. They found that for women whose DCIS was classified as low-grade by a pathologist looking at the cells under the microscope, surgery didn't offer a significant survival advantage over 10 years.