“Another year and I could have been in big trouble”

“Everyone gets busy, but don’t make excuses. I stay in shape and eat right, and it happened to me. Another year and I could have been in big trouble.”

Martina Navratilova was talking about her diagnosis of Ductal Carcinoma in Situ (DCIS) following a mammogram.  She will no doubt be learning the facts about DCIS and breast cancer as she goes through treatment and beyond.    Unfortunately, the public will be stuck with the misinformed messages that Martina has sent out during the early days of her diagnosis.  She will probably learn that DCIS shouldn’t be called breast cancer.  She may learn an NIH consensus panel on DCIS has recently called for a name change to remove “carcinoma” in order to prevent the exact reaction exhibited by Martina – the anxiety, shock, fear, and misunderstanding. 

Cancer means abnormal cells have become invasive.  In most breast cancers, this means abnormal cells have moved out of the milk ducts into surrounding tissue.  DCIS are abnormal cells that haven’t become cancerous or invasive yet.  They may in the future, but often do not.   Researchers estimate that up to 50% of DCIS won’t ever go on to become invasive, and there is some research suggesting that DCIS may even disappear over time.

DCIS is a product of mammography.  The diagnosis was relatively rare before the widespread onset of mammography.  Now, for every four women diagnosed with invasive breast cancer, one is diagnosed with DCIS.  Has this really meant preventing more invasive breast cancer?  Probably not.  There hasn’t been a corresponding  drop in breast cancer incidence following the dramatic rise in the incidence of DCIS.   There has only been a dramatic rise in the number of women experiencing the fear and anxiety, surgery, and radiation therapy that Martina is experiencing.

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  • andre dupont  On April 14, 2010 at 10:24 pm

    The only question I have is: if she was already in grade 3, which is already agressive, would that have worsened 1 year after? My guess is yes even if your answer is ‘we don’t know’.

    • breastcanceradvocate  On April 15, 2010 at 9:11 am

      Thanks for your comment Andre. You are right – some DCIS may be more aggressive and have a greater chance of becoming invasive cancer. But there was no indication that Martina’s was more aggressive than average and the odds are against it.

      From the NIH consensus report on DCIS “numerous studies, including randomized controlled trials, show a consistent association between younger age at diagnosis and an increased risk for adverse outcomes. These studies also demonstrate poorer outcomes among women whose DCIS was detected by symptoms compared with women whose DCIS was detected by screening mammography alone. In addition, several studies—including one analysis of more than 15 years of Surveillance, Epidemiology, and End Results (SEER) data (1988–2003)—demonstrate higher breast cancer mortality and recurrence rates among black women who have DCIS compared with white women who have DCIS.” The report also emphasizes that any of these differences are very small because the overall mortality for DCIS is so low (1-2%).

      We do need a better way to distinguish between abnormal cells that will become invasive and those that won’t. But comments from celebrities like Martina Navratilova help focus people on the wrong messages and too many resources continue to be put in the wrong places. We can keep doing more and more mammograms and finding more and more DCIS, but that is not going to do much to lower the deaths from breast cancer in our country.

  • Ann Hernick  On April 15, 2010 at 8:44 am

    Hey, I missed your comments! Glad you are back and tellin’ it like it is!

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