Is Breast Cancer Being Overtreated?

on Friday, August 2, 2013

Due to advances in screening, more breast cancers are being caught in their earliest, most curable stages. Yet, despite having relatively favorable prognoses, patients are often faced with treatment choices that balance small gains in outcome with possible negative effects.

For example, women with precancerous changes in their breasts, such as ductal carcinoma in situ (DCIS), must decide whether to receive treatment — surgical, radiotherapeutic, and/or medical — to lower their risk of developing cancer, even though it is not certain that such changes would develop into potentially life-threatening cancers if left treated. Furthermore, in women who cannot be diagnosed using needle biopsy, surgery to remove the abnormality is the only reliable way to exclude the presence of cancer.

Medical oncologist Larry Norton and breast surgeon Monica Morrow are available to weigh in on these topics. Each can discuss a paper published on July 29 in the Journal of the American Medical Association (JAMA) that recommended that DCIS be renamed, eliminating the word carcinoma, so patients would be less frightened and hence more likely to decide not to undergo possibly preventive treatments.

Dr. Morrow is also available to discuss a commentary she coauthored, published in JAMA on August 1, which addresses the issue of contralateral prophylactic mastectomy (CPM), a procedure in which the diseased breast is removed along with the cancer-free breast. For most women, the likelihood of a new cancer developing in the second breast is much lower than the risk of the cancer metastasizing, yet more women are choosing to have this more extensive surgery largely to lessen their fears of recurrence.