An article Thursday on the results of a study indicating that aggressive surgical treatment of a possible precursor to breast cancer may be unnecessary prompted a wide range of responses from readers, among them anger, sadness and relief.
Many commenters said they — or their wives,mothers, daughters or other family members — had undergone either a lumpectomy or a mastectomy after receiving a diagnosis of ductal carcinoma in situ, or D.C.I.S., which involves abnormal cells confined to the milk ducts of the breast. The study’s lead author concluded that these procedures are not the best option for most women who have what is commonly called “Stage 0 cancer” because an analysis of 20 years of data showed the course of treatment made little difference in patients’ outcomes and that the chance of these patients dying from breast cancer was about the same as the general population.
“I think the best way to treat D.C.I.S. is to do nothing,” Dr. Steven A. Narod, the lead author of the study, which was published in JAMA Oncology, is quoted as saying in the Times article.
Readers whose surgery turned up more advanced cancers disagreed with Dr. Narod’s position. Many expressed relief about the choice they made.
“I will not be the statistic representing those who did not act,” said Aurace Rengifo of Miami Beach, Fla., who said she received a diagnosis of D.C.I.S. in 2006. “After my lumpectomy, it was detected that my cancer was not grade 0 but grade 1. I also had radiation therapy. I am, thank God, in remission and I would do it again in the same situation.”
Jennie Thompson of San Diego said that after she had a mastectomy, “analysis of the tissue post-surgery revealed many areas of cancer throughout the breast.” She concluded: “Losing a breast is nothing compared to living with fear the cancer will resurface.”
E. Rosner of Berkeley, Calif., said she sought a second opinion after a D.C.I.S. diagnosis and lumpectomy in 1998. “In my case, a lymph nodedissection (during a 2nd surgery) revealed 1 positive node and changed my diagnosis to invasive cancer, leading me to undertake chemo and radiation (both of which treatments I definitely would have avoided otherwise). No way of knowing this, but I suspect that had I moved forward with the false D.C.I.S. diagnosis, I’d be dead by now.”
Other readers were angry to learn they might have undergone possibly unnecessary procedures.
“Suspected this all along,” said SK of Concord, N.H. “Knowing it was probably unnecessary was the hardest part of treatment for me.”
“I had needle core biopsy, 2 lumpectomies, radiation and am going to soon undertake hormone therapy. I realize I do not have invasive cancer and am grateful,” said Cindy of Oregon. “But yes, I say, it was brutal.”
But even readers upset by the news differed on whether they would take the same course of action again.
“I railed against the idea of there being a ‘Stage 0’ cancer. It still infuriates me that I went through surgery (lumpectomy) and radiation treatment for what I believed at the time was possibly a ‘blip’ rather than a serious cancer,” said Judith of Asheville, N.C. “Waiting and watching is a good idea and what I wish I had done.”
Kathy Daly of Denver, Colo., said she was received a D.C.I.S. diagnosis in January 2014 and then one of melanoma in October 2014. “I then discovered that the incidences of melanoma for those having been treated for breast cancer are higher than the statistical norm. So, to read this article and realize that all or most of this could have been avoidable is very disconcerting. (And, as I type this, I am experiencing a whopper of aTamoxifen induced hot flash!),” she said. “At the same time, I cannot imagine doing nothing and just waiting.”
Some called the push to operate a money grab by doctors.
“I am angry as hell at this assembly line they stuck women on,” wroteNuschler from Cambridge, Mass. “Because it made people a LOT of money. That month in October of pink ribbons, pink N.F.L. uniforms and 10K runs raised a lot of cash. And surgeons and radiologists and med centers jumped in and grabbed as much cash as possible. Even second and third opinions said the same thing! And I’m an MD!”
Winker of Atlanta wrote: “Women do not overestimate their risk, they have been encouraged to overestimate the risk. Physicians make a lot of money by aggressively treating 97 percent of the D.C.I.S cases and it is a battle for every recommended treatment a woman tries to refuse. It is tragic, it is barbaric and as someone affected by this, it is beyond infuriating. ”
Get multiple opinions, urged many medical professionals who wrote.
“Would like to encourage women everywhere to get a second opinion on treatment from a ‘compassionate conservative’ and don’t forget about a second opinion on your pathology. Doctors are human after all and mistakes happen,” said Gemma of Austin, Tex., a pathologist.
Des of Worthington, Ohio, said, “As a physician involved in breast cancer treatment, I would agree with the general philosophy that many times less treatment is better. But treatment needs to be individualized to the patient and based on data and personal preference, not on anecdotal stories of treatment gone horribly wrong. My recommendation would be to seek care at a tertiary facility that specializes in breast cancer treatment to make the most informed decision about your care if you have access to such a place.”