Breast cancer update: leave that lump alone!

July 10, 2014 (Updated: August 16, 2018)
Lily Moran

If you or someone you know is dealing with breast cancer – or if you simply want to stay current with new developments on that front – I have some good news.

Hundreds of thousands of women (and even some men) who will be diagnosed with the disease don’t need to suffer through harmful, costly, and sometimes disfiguring treatments any longer.

Here’s why: As many as 30 percent of all breast cancer diagnoses are for premalignant conditions, like ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).

Highly sensitive screening technology has made it possible to identify DCIS and LCIS, conditions that would never have been noticed a few years ago.

Unfortunately, once they’ve identified these milk-duct or lobule abnormal cells, some doctors insist on a biopsy, as well as treatment and removal, as precautionary measures.

The question is, is treatment necessary or should DCIS or LCIS be left alone?

DCIS is very common, not invasive, and widely believed to be non-life-threatening, with a roughly 20 percent chance of becoming malignant. In other words, just because it was found during a mammogram doesn’t mean it’s lethal or has to be treated.

LCIS (also known as mammary adenosis) shows up on mammograms or is found during biopsies. It’s a non-malignant condition in the milk duct lobules, but it is sometimes treated with drugs like tamoxifen, which is known to cause severe side effects as well as several types of cancer.  And in the worst cases, a patient receives a completely unnecessary mastectomy.

I understand the “better safe than sorry” approach. But these lesions are not cancerous. In fact, they are classified as stage 0 on a scale of 0 to 4.  How much less dangerous could they be?

And while it may seem sensible to eliminate anything that could become cancerous, the truth is this type of prophylactic measure is neither safe nor effective.

Biopsies, surgery, and radiation all have serious consequences. Biopsies and surgery, for example, can spread cancer cells to new areas of the body. Radiation itself is a known cause of cancer.

These needless treatments have convinced many health experts that it’s time to remove the word “carcinoma” (a name for a specific type of cancer) from these diagnoses.

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The debate over whether or not to drop “carcinoma” isn’t settled yet. But you should know that if you’re diagnosed with either of these conditions, you do not have cancer!

Does it really matter what a disease is called? As it turns out, yes, names do make a difference, especially when it comes to treatment.

A study published last year in JAMA Internal Medicine shows why. Researchers found that when women were told DCIS was a type of cancer, they wanted surgery or other aggressive treatment.

Meanwhile, women who were told the condition was due to abnormal cells or a simple lesion were willing to skip treatment in favor of keeping an eye on the situation in case it changed.

Redefining treatment options can reduce hundreds of millions of dollars in health care expenses and emotional distress. Even a conservative organization like the National Cancer Institute admits that over-diagnosis is a major public health issue.

Over-diagnosis drives up costs, and exposes patients to needless complications, expenses, and risks, not to mention the overwhelming stress and psychological trauma of being told you have cancer.

But what about the genetic link to breast cancer? If you’re worried about your genes, I have great news for you!

The most important thing you need to know about genetics is that genes only account for 5 to 10 percent of all cancer cases. So even if you have the BRCA1 or BRCA2 gene, your risk is not especially high.

What about the prophylactic removal of perfectly healthy breasts? Actress Angelina Jolie caused a sensation last year when she had a “preventive” double mastectomy because she had genes that increased the likelihood of a cancer diagnosis.

As a doctor, I’m appalled that healthy people would go to such lengths to avoid a disease they don’t have and may never get. But cancer has a remarkable power to terrify people.

Even worse, research shows that nearly 70 percent of the women choosing preventive mastectomies have no genetic risk factors. And of course, having a mastectomy does not guarantee you’ll never get cancer.  There are many more places in the body where the disease can start.

If you’re serious about avoiding cancer, I highly recommend reviewing my Pillars of Health for guidelines on healthy living, which is the best cancer preventive, bar none! There are many steps you can take to reduce your risk of cancer and enhance your overall health. And the sooner you start, the better!

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