Many tests follow surgery for early breast cancer
Women who have early breast tumors surgically removed may often go through repeat mammograms and invasive procedures for years afterward, a new study finds.
The study focused on so-called ductal carcinoma in situ, or DCIS - abnormal cells in the milk ducts that are considered the earliest stage of breast cancer.
The most common treatment is breast-conserving surgery, where the surgeon removes only the abnormal tissue and avoids a mastectomy (removal of the breast).
In the new study, researchers found that of nearly 3,000 women who had the surgery, two-thirds ended up having at least one more invasive procedure over the next decade - usually a biopsy to remove abnormal tissue in the same breast.
The findings, which appear in the Journal of the National Cancer Institute, point to a downside of breast-conserving surgery for DCIS.
“Women making treatment decisions about DCIS need to understand that many women will need additional surgery or invasive intervention after breast-conserving surgery,” said Dr. Joshua Fenton, an assistant professor at the University of California, Davis, who co-wrote an editorial published with the study.
Do you know that approximately 15% of all breast cancers occur in women under 45?
This is the most common cancer in women in this age group. Breast cancers in younger women are usually more aggressive and have poorer survival rates. Breast thermography offers younger women a valuable imaging tool that they can add to their regular breast health check-ups beginning with baseline imaging at age 20.
The other treatment option is a mastectomy, which many women may want to avoid.
“We’re not suggesting that women have a mastectomy instead,” said study leader Dr. Larissa Nekhlyudov, of Harvard Medical School and Harvard Vanguard Medical Associates in Boston.
Instead, she told Reuters Health, women should be aware that breast-conserving surgery can come with a long follow-up.
Overdiagnosis is a real problem linked to early screening.Two important reasons to worry are: 1) it leads to further tests and possible, aggressive treatments in women, that are not needed, and are harmful, and 2) no current tracking tools are available to pinpoint which of the women fall in this category, to help reduce incidences of false positive treatments.
Most guidelines recommend mammograms for older women, but there are differences about what age they should start and how frequently they should be done. For example, women with a history of breast cancer in their family, and in particular their immediate family (parents and siblings) may require earlier testing than age 40, which is the starting age recommended by the American Cancer Society.
Compare the American Cancer Society’s age guideline to that of The U.S. Preventive Services Task Force (USPSTF), which recommends ages 50 to 74 years receive mammograms, every two years. Therefore the USPSTF is “against routine screening mammography in women aged 40 to 49 years.”
“The good news is that the majority of these women will not have a (cancer) recurrence,” Nekhlyudov said. “But the work-ups for a possible recurrence are likely to continue for years.”
Both Fenton and Nekhlyudov said women with DCIS should talk with their doctors about the pros and cons of all their treatment options. (Women who have breast-conserving surgery often also receive radiation therapy.)