'New' Type of Breast Cancer Stops Women in Their Tracks
Breast cancer walk names. Courtesy of Creative Commons.
October 12, 2009
When a mammogram detected a lump in Barbara Laufer’s breast, the fear was paralyzing.
“You think you’re going to die,” says Laufer, 40, of Burbank, Calif.
Laufer was diagnosed with a perplexing condition called ductal carcinoma in situ, or DCIS, a growth of malignant cells inside the milk ducts of the breast. Though some doctors describe the condition to patients as a very early breast cancer, others compare it to a precancer.
Although the disease is almost never life-threatening, Laufer says the diagnosis put her life on hold.
She has had three surgeries, including two lumpectomies that disfigured her right breast. She spent seven weeks in daily radiation treatment. And she has had to delay trying to have children for five years while she takes a hormonal treatment called tamoxifen, which can cause birth defects.
“The huge effect from DCIS is that my life has to stop,” says Laufer, who was diagnosed at 37 and recently began taking the drug. “I can’t have babies. I’m going to have to wait until I’m 44 1/2 until I can even find out if I can. It’s just really poor timing for me.”
The advent of mammograms
More than 60,000 American women are diagnosed with DCIS each year. Doctors would like to spare these women from the rigors of cancer therapy, says breast oncologist Patricia Ganz, a professor at UCLA’s Jonsson Comprehensive Cancer Center. But doctors today don’t know enough about DCIS to tell a harmless tumor from one that could turn lethal. As a result, they tend to treat all women the same, regardless of the tumor’s size.
“We’re asking women to make decisions that are crucial to their lives, without a lot of hard evidence,” says Susan Reed, an obstetrician-gynecologist at Seattle’s Fred Hutchinson Cancer Research Center, who served on an expert panel on DCIS last month at the National Institutes of Health. “We’re giving them a lot of uncertainty.”
If doctors know so little, it’s partly because DCIS is so new.
“When I started my career, this disease did not exist,” says Ganz, who has been in practice for 30 years.
The incidence of DCIS has grown seven-fold since the early ‘70s, when doctors began using mammograms, says the University of Florida’s Carmen Allegra, a cancer specialist and chairman of the NIH panel.
Mammograms, which take X-rays of the breast, can find tumors that are too small to be felt by hand.
Doctors, who had never seen such tiny tumors, assumed that they should treat them like the large, lethal masses they were used to finding. They piled on additional treatments over the years as studies showed that radiation and hormonal therapies further reduced the risk of relapse.