Some in the medical field are trumpeting a "watch-and-wait" approach
, leaving women with a misunderstanding of the best possible treatment
Ductal carcinoma in situ is the presence of cancer cells inside the milk
ducts of the breast, and is commonly referred to early-stage, or Stage
0, breast cancer.
Cancer at this stage is not invasive, but has the potential to become so
when given enough time. Some are calling for a "watch-and-wait"
approach, which means forgoing traditional cancer therapies, such as surgery
and radiation, and instead using active imaging surveillance to monitor
Although the trials to support this new theory are pending, a distorted
message has gained traction in the media over the last two years, confusing
women and clouding judgment of what might be the best treatment plan.
The "watch-and-wait" school of thought argues that we may be
over-treating ductal carcinoma in some patients as the mortality rates
are low with non-invasive breast cancer. While this may hold true for
some women, we don't understand enough about the biology of the cancer
to know which patients are being over-treated versus which patients'
lives are being saved with standard treatment.
To help shed light on this complex question of whether there is a select
group of patients with ductal carcinoma who may qualify for less treatment, me and
Dr. Melvin J. Silverstein queried the database of pure DCIS patients and found 720 who were treated
with excision alone.
A total of 596 of the women had the tumor removed with cancer-free margins
of at least 1 millimeter of normal tissue around, which we considered
adequate surgical excision. We compared those patients with 124 women
who had tumors removed with less than 1 millimeter of cancer-free margin around.
This second group of women were considered inadequately treated, as per
the current national cancer guideline recommendations, and therefore,
considered a surrogate for no treatment in our study. These patients were
recommended to undergo either re-excision for close margins or to go on
to have whole breast radiation therapy, but refused any additional treatment.
We found that leaving even low-grade ductal carcinoma untreated led to
local recurrence in more than half of patients at 10 years. And when patients
did reoccur, half of the recurrences were invasive disease with the potential
to spread elsewhere in the body. In high-grade DCIS the recurrence rate
is 70% at 10 years. These numbers are simply too high to advocate for
a "watch and wait" approach as a safe option for patients with
While saving a life is of utmost importance, women also deserve to be saved
from enduring the physical and emotional pain of battling cancer a second time.
Dr. SADIA KHAN is program advisor to Hoag Breast Care Program, Hoag Memorial Hospital
Presbyterian, Newport Beach.