Women's Perception of
Precancerous Lesion a Concern

Many women diagnosed with a precancerous breast lesion known as ductal carcinoma in situ (DCIS) face a low risk of a recurrence or developing invasive breast cancer, says a study in the Journal of the National Cancer Institute.

The diagnosis can cause anxiety in women, but researchers say not to worry so much.

"Many of these women are living as if they're waiting for the other shoe to drop," says lead researcher Dr. Ann Partridge, an oncologist at the Dana-Farber Cancer Institute in Boston.

DCIS involves abnormal cells in the lining of the breast duct that have not spread outside the duct, according to the National Cancer Institute (NCI).

In 2006, DCIS accounted for more than 20 percent of all diagnoses linked to breast cancer in the US — about 62,000 cases.

Experts say the increasing percentage of DCIS diagnoses over the last 20 years or more has been attributed to improved detection from the increasing use of screening mammography.

Stress Leads to Inaccurate View
The study notes that 28 percent of the participants "believed that they had a moderate or greater chance of DCIS spreading to other places in their bodies, despite the fact that metastatic breast cancer actually occurs following a diagnosis of DCIS less than 1 percent of the time."

The study included nearly 500 women newly diagnosed with DCIS.

"In the complex treatment decision-making process, it is often possible to lose sight of the fact that DCIS poses limited risks to a woman's overall mortality," the study authors note.

Nevertheless, approximately 39 percent of women surveyed thought they had at least a moderate risk of getting an invasive breast cancer over the next five years, and 53 percent reported "intrusive" or "avoidant" thoughts about DCIS.

That number declined to 31 percent 18 months after diagnosis, the researchers say.

Among the 487 study participants who were newly diagnosed with DCIS, 34 percent had undergone a mastectomy, 50 percent had radiation therapy, and 43 percent reported taking tamoxifen to reduce their chances of breast cancer.

The type of treatment or combination varied by surgeon, hospital volume, and geographic region.

"Although decision-making about treatment is complex, there is little doubt that women will be limited in their ability to participate in informed decision-making if they harbor gross misperceptions about the health risks they face," the authors say.

Researchers found a "strong relationship between distress and inaccurate risk perceptions."

One of the difficulties of such measures of anxiety about DCIS is that the study did not determine what these patients had learned from their physicians or from other sources — such as the Internet — about DCIS, and how accurate that information was, says Michael Stefanek, Ph.D., of the American Cancer Society (ACS).

The choice of treatment depends upon the characteristics of the patient and the lesion, adds Dr. Partridge.

The dilemma posed by the prospect of under- or over-treating DCIS is complicated by medicine's current inability to distinguish between "good actors and bad actors" — lesions that do not recur or go on to become invasive breast cancer and those that do, she adds.

Another expert agrees with that assessment.

Everyone would be more comfortable if there was not such a "big gray zone" between what is normal tissue and what is invasive cancer, says Dr. H. Gilbert Welch, at Dartmouth Medical School.

Make Careful Treatment Choices
Dr. Welch argues that as mammography continues to detect smaller and smaller DCIS lesions, there can be a tendency to over-treat.

He recommends that the diagnostic threshold for DCIS be raised to doing biopsies on only lesions that measure 1 centimeter or greater in diameter, which is about four-tenths of an inch.

"There is this ironic finding that women with this early precursor lesion may be treated more aggressively than women with invasive breast cancer," he says.

"They may have mastectomies instead of just a lumpectomy. At some level we have to say, 'Does this really make sense?" he asks.

Always consult your physician for more information.

Online Resources

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American Cancer Society

Department of Defense - Breast Cancer Program

Journal of the National Cancer Institute - Risk Perceptions and Psychosocial Outcomes of Women With Ductal Carcinoma In Situ: Longitudinal Results From a Cohort Study

National Breast Cancer Coalition

National Cancer Institute (NCI)