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Special populations: African American Women, People with DCIS
Diagnoses of ductal carcinoma in situ (DCIS), sometimes called stage 0 breast cancer, have increased in recent decades. Many people with DCIS wonder if they need aggressive treatment. A recent study looking at the survival of over 100,000 women found that breast cancer mortality after DCIS is low (3%), and identified groups of women who are at higher risk after DCIS.
Estimating breast cancer mortality after a DCIS diagnosis and identifying which factors, such as age, ethnicity, and initial treatment received, increase a DCIS patient’s risk of dying from breast cancer.
The study agrees with previous work that shows a low death rate from breast cancer after DCIS diagnosis. The study found a 3.3% risk of death from breast cancer after 20 years beyond a DCIS diagnosis. Finding common factors in women with DCIS who eventually died from breast cancer can help physicians learn who might benefit from more aggressive treatment, which will translate into helping patients and their doctors decide on the best course of treatment.
The study showed that the risk of dying from breast cancer after a DCIS diagnosis is generally low, and it opens the possibility of discussing less aggressive treatment alternatives with patients’ health care providers. However, the study identified two groups of women with higher breast cancer mortality after DCIS—young women who are diagnosed with breast cancer (under 40 years old) and African American women who are at higher risk of dying from breast cancer. It is important for women in these two groups to discuss DCIS treatment options and heightened surveillance with their health care providers.
The San Diego Union Tribune
Although DCIS cells are abnormal, they are not the same as invasive cancer cells. Unlike invasive cancer, DCIS lacks the ability to metastasize (spread to other areas of the body). Scientists long believed that untreated DCIS cells could turn into invasive cancer, which might then spread to other parts of the body and cause death. For this reason, DCIS lesions are generally removed and the remaining breast is treated with radiation to kill off any lingering cancer cells. However, data from previous studies and this more recent study show that even left untreated, DCIS seldom leads to death, and that removing DCIS does not help most women live longer. This study was done to learn which risk factors are associated with breast cancer mortality after a DCIS diagnosis.
How many women previously diagnosed with DCIS eventually die from breast cancer, and which women are at greatest risk for breast cancer death after DCIS.
Data from approximately 108,000 women who were diagnosed with DCIS from 1988-2011 were obtained from the National Cancer Institute’s SEER (Surveillance, Epidemiology and End Results) database. SEER collects information on all patients diagnosed with cancer, including the site of the primary cancer; the stage of cancer at diagnosis, the first course of treatment; specific markers, such as HER2, ER, and PR; and patient survival. Research using databases such as SEER is useful in designing controlled studies that compare how different treatment options affect survival.
Researchers were unable to tell which cases of DCIS were detected through screening and which cases were symptomatic. The researchers did not have access to information that could affect risk of recurrence and/or second primary breast cancer such as:
This study highlights two populations who have a higher risk of breast cancer mortality after DCIS diagnosis: young women (under 40) and African American women. As breast surgeon Dr. Laura Esserman said in an editorial that was published on this study, “For young women (<40 years) who present with symptomatic DCIS—approximately 5% of the population—we should be cognizant that this is a different disease than typical DCIS.” Esserman noted that new tests that look at a patient’s tumor can help health care providers identify which patients with DCIS could benefit from more aggressive treatment.
This study did not look at patients’ BRCA status or their family history of breast cancer. While the study shows that the risk of dying from breast cancer after a DCIS diagnosis is generally low, young women and African American women should be monitored more regularly and more thoroughly. Women diagnosed with DCIS before the age of 50 meet national guidelines for referral to genetic services; they may wish to discuss the possibility of genetic counseling and/or testing with their health care provider.
Experts note that this study alone does not mean that doctors should stop treating women with DCIS; rather, it is an indicator for further discussion and research on how to best treat DCIS in different populations.
Narod SA, Iqbal J, Glannakeas V, et al. “Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ.” JAMA Oncology, initially published online August 20, 2015.
Esserman L and Yau C. “Editorial: Rethinking the Standard for Ductal Carcinoma In Situ Treatment.” JAMA Oncology, Initially published online August 20, 2015.