With evidence from a number of studies, this presentation delves into the controversy surrounding the treatment, or overtreatment, of ductal carcinoma in situ (DCIS), and discusses whether or not these lesions should indeed be classified as breast cancer.
Are We Overtreating DCIS?
Cancer Is a Collection of Heterogeneous Diseases
Definition of Cancer
Patients Assume That Cancer, Left Untreated, Will Kill You: Physicians Do Too
Old Paradigm: Inexorable Progression
Pathways for Progression
March 2012 Workshop
Recommendations Working Group
Overdiagnosis Occurs and Is Common.
Overdiagnosis Is More Common With Screening
For Both Breast and Prostate: Incidence Rates Have Risen and Remain Higher
Chance Increases With Screening
Noninvasive Cancer
What Is the Problem With Diagnosing All of These Cancers?
Treatments Have Consequences
Recommendations to the NCI
Recommendation #1: Embrace the Development of New Terminology to Replace the Word “Cancer” Where Appropriate
Establish a New Naming Convention
DCIS Has Increased 500% Since the Advent of Mammographic Screening
Comparison
It Is Unlikely That the Majority of DCIS Detected Is Destined for Significant Cancers
Recommendation #2: Create Observational Registries Where There Is Uncertain Risk of Progression to “Metastatic” Cancer
DCIS Is an Excellent Example: No Emergency to Operate
Incorporate Disease Dynamics Into Pathology Paradigm
Time Can Be Used as the Discriminator of Who Needs Surgical Intervention
If We Continue on the Same Clinical Path, We Cannot Hope to See Change: If We Study an Alternative Approach, We May Be Surprised at What We Learn
Remarkable Variation in Approach to Management of “Risk”
Interesting Studies
DCIS Score: 10-Year Ipsilateral Breast Events (IBE) by Risk Group
Atypia and Chemoprevention
Probability of Cancer After Atypia Diagnosis With and Without Chemoprevention
Invasive Cancer Risk
The Evidence Supports Overdiagnosis and Overtreatment of DCIS
Recommendation #3: Mitigate Overdiagnosis by Testing Strategies That Lower the Chance of Detecting Unimportant Lesions
What Is the Magnitude of the Problem in Screening?
Embracing Learning and Change Going Forward
Changing the Threshold
ATHENA Reader Study
Ways to Find Less DCIS
Recommendation #4: Embrace New Concepts for How to Approach Cancer Progression and Prevention
Biology Determines the Type of Progression
What Can Clinicians Do Today?
The Evidence Supports Overdiagnosis and Overtreatment of DCIS