by Sayer Ji
Early detection through x-ray mammography has been the
clarion call of Breast Cancer Awareness campaigns for a quarter of a
century now. However, very little progress has been made in making the
public aware about the crucial differences between non-malignant
lesions/tumors and invasive or non-invasive cancers detected through
this technology. When all forms of breast pathology are looked at in
the aggregate, irrespective of their relative risk for harm, disease of
the breast takes on the appearance of a monolithic entity that you
either have, or don't have; they call it breast cancer .
The concept of a breast cancer that has no
symptoms, which can not be diagnosed through manual palpation of the
breast and does not become invasive in the vast majority of cases, might
sound unbelievable to most women. However, there does exist a rather
mysterious clinical anomaly known as Ductal Carcinoma In Situ (DCIS)
which is, in fact, one of the most commonly diagnosed and unnecessarily
treated forms of 'breast cancer' today.
What women fail to understand - because their physicians
do not know better or have not taken care to explain to them - is that
they have a choice when diagnosed with DCIS. Rather than succumb to
aggressive treatment with surgery, radiation and chemo-drugs, women can
choose watchful waiting. Better yet, a radical lifestyle change can be
embraced focused on eliminating exposure to chemicals and radiation, as
well as improved exercise and nutrition. Unfortunately
this choice is not being made in most cases because the medical
community is not informing their patients that there is one.
This article aims to fill the information gap in order to educate
and empower women who, by accident or design, have been or are at threat
of being misdiagnosed and consequently mistreated (in more ways than
one) by the medical establishment.
DUCTAL CARCINOMA IN SITU: BREAST CANCER OR BENIGN LESION?
Up to 33% of new breast cancer diagnoses obtained through x-ray mammography screenings are classified as Ductal Carcinoma In Situ (DCIS). DCIS refers to the abnormal growth of cells within the milk ducts of the breast forming a lesion commonly between 1-1.5 cm in diameter, and is considered non-invasive or "stage zero breast cancer," with some experts arguing for its complete re-classification as a non-cancerous condition.
Because DCIS is almost invariably asymptomatic and has no palpable lesions, it would not be known as a clinically relevant entity were it not for the use of x-ray diagnostic technology. Indeed, it was not until the development and widespread application of mammography in the early 1980s as the central push behind National Breast Cancer Awareness campaigns that rates of DCIS diagnosis began to expand to their present day epidemic proportions.1 It is no wonder, therefore, that the United States, which has one of the highest x-ray mammography rates, also has the highest level of DCIS in the world. As of January 2005, an estimated one-half million U.S. women were living with a diagnosis of DCIS.2
Proponents of breast screenings claim they are "saving lives" through the "early detection" and treatment of DCIS, regarding it as a potentially life-threatening condition, indistinct from actually invasive cancers. They view DCIS a priori as "pre-cancerous" and argue that, because it could cause harm if left untreated it should be treated in the same aggressive manner as invasive cancer. The problem with this approach is that while the rate at which DCIS progresses to invasive cancer is still largely unknown, the weight of evidence indicates that it is significantly less than 50% - perhaps as low as 2-4%. Indeed, the 10-year survival rates of patients with DCIS (96%-98%) post-treatment speaks volumes to the relatively benign nature of the condition.3,8 Another study found that at the 40 year follow-up period 40% of DCIS lesions still had no signs of invasiveness.4 Adding even more uncertainty, another study showed that coexisting ductal carcinoma in situ independently predicts lower tumor aggressiveness in node-positive luminal breast cancer, indicating its possibly protective role. 5
IS WATCHFUL WAITING THE MORE INTELLIGENT APPROACH?
A solid argument can be made that watchful waiting is the most appropriate response to the diagnosis of DCIS, and that in many cases DCIS would be better left overdiagnosed and under-treated. As one paper discusses:
"The central harm of screening is overdiagnosis--the detection of abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms." [ Source ]
A solid body of evidence has emerged suggesting that when DCIS is left undiagnosed and untreated rarely will it become malignant. DCIS was in fact poorly named from the outset, as it is does not behave like most carcinomas (cancers). Cancer, like the constellation named after it, derives from the Greek word for CRAB, indicating the manner in which is expands outward in uncontrolled growth. In situ means exactly the opposite, "in place." An unmoving cancer is therefore a contradiction in terms. These problems with classification have not gone unnoticed in the medical journals:
"Despite the presence of the word "carcinoma," ductal carcinoma in situ (DCIS) is the poster child for this problem (a senior pathologist involved in developing classification systems confided to one of us that he regretted the use of the term carcinoma in DCIS). No one believes that DCIS always progresses to invasive cancer, and no one believes it never does. Although no one is sure what the probability of progression is, studies of DCIS that were missed at biopsy ( 1 , 2 ) and the autopsy reservoir ( 3 ) suggest that the lifetime risk of progression must be considerably less than 50%." [ Source ]
The true irony here is that while participation in x-ray mammography is considered by the public a form of breast cancer prevention and "watchful waiting," it has become - whether by design or accident - a very effective way of manufacturing false breast cancer diagnoses and justifying unnecessary treatment. This is not unlike what has been seen with prostate cancer screenings that track Prostate Specific Antigen (PSA); the aggressive treatment of lesions/tumors identified through PSA markers may actually increase patient mortality relative to doing nothing at all.
Women diagnosed with DCIS are simply not given the option to decline treatment. The problem is illustrated below:
"Because the "best guess" is that most DCIS won't progress to invasive cancer, the risk of overdiagnosis would be expected to be greater than 50%. The problem with overdiagnosis is that it leads to overtreatment. Because it is impossible to determine which individuals are overdiagnosed, almost everyone gets treated as if they had invasive cancer." [ Source ]
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