Over-treatment of ductal carcinoma in situ

Nine out of ten women do not know that some breast cancers never cause problems or would never have become known in their lifetime. This is a problem that ductal carcinoma in situ has brought to the fore.

The purpose of cancer screening is to “recognize life-threatening illness at an earlier, more curable stage. Effective cancer screening programs therefore increase both the incidence of cancer that is detected at an early stage and the incidence of cancer that presents at a late stage. ”Sounds reasonable, because you would be screening all these small cancers find that you would have missed before and be able to cut them out and take them out of circulation. However, that doesn’t seem to be the case with mammograms as you can see at 0:30 in my video Overtreatment of stage zero breast cancer DCIS. As a mammography battered In the 1980s, early-stage cancer diagnoses actually skyrocketed. What we then like to see is a reflection of that surge, with the incidence of late-stage cancers falling. If you could spot cancer early, it wouldn’t be there for late-stage cancer, right? Not correct. The late-stage cancer incidence did not seem to be decreasing much.

Another way to see this is through to compare Mammogram rates across the country. The more mammograms you do, the more screened the population will be and the more early-stage cancers will be detected. Big! And late, advanced illnesses should go down too, right? True, but it doesn’t. As you can see in mine at 0:59 Video, so many cancers are early-stage out of print be withdrawn by surgery, radiation, or other treatment, which should mean that roughly the same number of late-stage cancers should not be found; i.e. but that didn’t happen. Mammograms capture many small cancers, but with “no concomitant decline in major cancer detection” that would explain why the more mammograms you do, the more cancer you find, but death from breast cancer doesn’t seem to change much. Hold tight. Tens of thousands of cancers are ruled out after screening. Why aren’t so many fewer women dying? “Taken together, these results suggest widespread overdiagnosis,” which means cancer selected on mammograms that would never have progressed so far during the woman’s lifetime and therefore would not have been noticed or damage would have been caused if they had never been taken.

So, back to the graph I showed earlier, which you can see again in mine at 2:00 PM VideoIf removing all of these early-stage cancers didn’t lead to so many late-stage cancers, it suggests that most of them would never have progressed or even go away on their own during that time. This may explain almost all of the increase in incidence seen with mammography screening. ”In fact,“ Many invasive breast cancers detected by repeated mammography screenings are not detected by screening after 6 years, suggesting that the natural history of many of the invasive breast cancers discovered through screening is “spontaneous regression”, that is, to disappear spontaneously.

We have known for more than a century that sometimes even severe metastatic breast cancer can go away spontaneously. The problem is, you can’t tell which is which, so when you can Find Cancer is the natural tendency to treat it. That can being particularly sensitive with ductal carcinoma in situ (DCIS), the so-called stage zero breast cancer. Ductal means “in the chest ducts”, carcinoma means “cancer” and in situ means “in place” or “in position”, does not spread outside the duct. And DCIS can create tiny calcifications that can be seen in the mammogram like you can see in mine at 3:07 Video.

The purpose of mammography was “to identify early invasive disease, so the large number of … diagnosed DCIS was unexpected and undesirable. “” Before the advent of screening, ductal carcinoma in situ (DCIS) made up to about 3% of the recognized breast cancers. ”Now DCIS makes up a significant part. “The cells that make up DCIS look like invasive cancer … so it was suggested that these lesions were the precursors to cancer” – stage zero cancer – and that early removal and treatment reduce cancer incidence and mortality would. However, that is the long-term epidemiology [population] Studies have shown that the [surgical] Removal of 50,000 to 60,000 DCIS lesions per year has not been associated with a reduction in the incidence of invasive breast cancer. This is in contrast to experience with colon polyp removal [with colonoscopy] and intraepithelial neoplasmic lesions of the cervix [precancerous cervical lesions, thanks to pap smears], where removal of precursor lesions has reduced the incidence of colon and cervical cancer. ”These are cancer screening programs that work.

Radiologists argue that overdiagnosis is less of a problem than over treatment. Surely getting a diagnosis of breast cancer is terrible even though the cancer would never have harmed you, but there is no way to know at this point, so most women undergo aggressive surgery and radiation. What if you to compare the 10-year breast cancer survival rate in women with low-grade DCIS? Of the women who chose not to have surgery, 1.2 percent died of breast cancer within a decade. But in the same decade, 1.4 percent of women who had surgery, a lumpectomy, or a full mastectomy to remove the cancer died of breast cancer. So the operation didn’t seem to make any difference.

C.Randomized controlled trials are currently being carried out guided to put it to the test, but it is “incredibly difficult to convince a patient with a proven diagnosis of DCIS to undergo standard surgical therapy” – many just want to do without it. “The fear of cancer paralyzes patients …[who may] resort to drastic therapeutic measures that may not be necessary, ”excessive measures such as a double mastectomy. how can we impede This? How about we change his name? “A research group at the US National Cancer Institute recommended that the term” carcinoma “be dropped, so maybe we should just … Call it is an “indolent lesion of epithelial origin”. Let’s “use language that is less fearful,” right? How bad can an “IDLE” tumor be?

Another option too avoid this dilemma? Don’t even allow yourself to be examined. However, women are usually not told about it. Less than one in ten women became know that mammograms have potential harm in the first place, and more than nine in ten were unaware that some types of breast cancers never cause problems. Few had heard of DCIS, but when told about it, most wished they had known before signing up for the screening.

“As soon as there is a cancer recognized, it is currently not possible to differentiate life-threatening from sluggish [potentially harmless] Cases. Therefore, overdiagnosis can only be avoided by doing without breast screening “and omitting mammograms altogether.

This is how the researcher Alexandra Barratt works explained Your own decision to avoid screening: “I am… concerned about the possibility of my being seriously harmed by treating a cancer that would never have harmed my health.” was not to have a mammogram, so she decided to improve her diet and lifestyle to prevent breast cancer in the first place.


  • The aim of cancer prevention is the early detection of a life-threatening disease when it is in a more easily curable stage. However, with the increase in mammography screening in the 1980s, the diagnosis of early-stage cancer rose while the incidence of cancer in the late-stage hardly declined.
  • Mammograms detect many types of cancer in the early stages, which can then be removed by surgery, radiation, or chemotherapy. Breast cancer that would never have endangered a woman’s health.
  • Many invasive breast cancers identified during mammography screening can go away spontaneously. Even severe metastatic breast cancer can resolve spontaneously, which has been known for more than a century.
  • The natural propensity to find cancer is to treat it, which is a particular challenge with ductal cancer in situ (DCIS), also known as stage zero breast cancer. DCIS can create tiny calcifications that can be seen on mammograms, and its cells look like invasive cancer. However, surgical removal of DCIS lesions has not been associated with a reduction in the incidence of invasive breast cancer.
  • Comparing the 10-year breast cancer survival rate in women with low-grade DCIS, 1.2 percent of women who chose not to have surgery died from breast cancer within a decade. During the same period, 1.4 percent of those who had a lumpectomy or complete mastectomy died of breast cancer. So the operation didn’t seem to make any difference.
  • To reduce the fear of cancer, which can paralyze patients, a research group at the US National Cancer Institute recommended that the word “carcinoma” be dropped in DCIS and changed to “indolent lesion of epithelial origin”, IDLE.
  • Avoiding screenings is another way to avoid overdiagnosis, but fewer than 1 in 10 women understand that mammograms have potential harm, and more than 9 in 10 do not know that some breast cancers never cause problems.

How could someone improve their diet and lifestyle to reduce their risk of breast cancer? See for example:

This is the ninth in a 14-part series on mammograms that includes:

You can find more information about breast cancer in my videos Oxidized cholesterol 27HC may explain three secrets of breast cancer, Eggs and breast cancer, and Flashback Friday: Can Flaxseed Prevent Breast Cancer?.

I was able to cover colon cancer screening in just one video. If you missed it, see Should we all have a colonoscopy over the age of 50?.

You can also find information on the subject of preventive medical examinations here Flashback Friday: Is It Worth Getting an Annual Health Checkup and Physical Exam?, Are annual health checks worthwhile?, and Is it worth doing an annual physical exam?.

In health,

Michael Greger, MD

PS: If you haven’t already, you can subscribe to my free videos here and check out my live presentations:

Related Articles