Thousands of women with a common form of breast cancer may not need any treatment, scientists suggested today.
About a fifth of all breast cancers are a type of slow-growing disease found in the milk ducts and known as ductal carcinoma in situ (DCIS).
According to current UK guidelines, treatment to tackle these early-stage cancers involves surgery followed by radiotherapy to kill any abnormal cells hiding in the breast tissue.
But American researchers, who followed hundreds of women with DCIS, found that this barrage of treatment makes little difference to whether the cancer progresses or not, or to survival.
The study compared the outcomes of women who received standard therapies with those who were offered a “watch and wait” approach.
This means they were monitored through scans and physical exams every six months.
After two years, the group of women who did not receive treatment had no greater risk of developing a more invasive form of cancer than those who did receive treatment.
Experts said today that the “provocative” findings could pave the way for a new protocol for women with DCIS, which could be implemented in as little as five years.
Ductal carcinoma in situ, or DCIS, is a slow-growing form of disease that is contained in the milk ducts and is routinely detected by screening tests. In the image, DCIS in breast tissue.
According to current UK guidelines, treatment to combat early-stage cancer involves surgery followed by radiotherapy to kill any abnormal cells hiding in the breast tissue.
Professor Eun-Sil Shelley Hwang, a radiology expert at Duke University in North Carolina, who presented the study today at the San Antonio Breast Cancer Symposium, said there was “no“There is growing evidence that not all DCIS are destined for progress.”
He added: ‘Current practice may lead to overtreatment of women whose tumors are at low risk of progression.
‘This can lead to chronic pain, altered body image, reduced quality of life and other side effects that can be avoided.
‘If these results are replicated in future studies, I believe they will change the way we practice. “I’m going to be optimistic and say this could happen within five years.”
DCIS affects around 4,800 Britons a year and is becoming more common because it is easily diagnosed through breast screening.
It is sometimes called a “precancer” because in a minority of cases it can develop into an invasive disease.
But doctors don’t know which cases of DCIS will be dangerous and which won’t.
In the UK, women are offered a mammogram (a special form of X-ray) every three years, between the ages of 50 and 70, to detect the disease in its early stages.
Breast cancer symptoms to look out for include lumps and swelling, dimpling of the skin, color changes, discharge, and a rash or crusting around the nipple.
In the study, researchers followed 673 patients with one of the most common types of DCIS cancer.
Just under two-thirds underwent follow-up rather than treatment, and the rest received surgery with or without radiation therapy.
Women in the follow-up group could choose to undergo surgery at any time and it was performed if the tumor showed signs of invasive progression.
Both groups may also choose to receive hormone therapy, which blocks hormones in the body that can help cancer grow.
During a two-year follow-up, 8.7 percent of the treatment group were diagnosed with invasive breast cancer.
This means that the cancer had spread from where it started in the same breast to the surrounding normal tissue.
By comparison, the figure stood at 3.1 percent among the follow-up group that received neither radiation therapy nor surgery.
The study, which was published today in the journal JAMAalso found that slightly more women in the active monitoring group (71.3 percent) chose to receive hormone treatment, compared with 65.5 percent in the standard group.
Checking your breasts should be part of your monthly routine so that you notice any unusual changes. Simply rub and feel up and down, in semicircles and circular motions around the breast tissue to identify any abnormalities.
However, among those who received endocrine therapy, the rate of invasive ipsilateral cancer was 7.15 percent in patients who received care according to current guidelines.
The figure stood at 3.21 percent in the active monitoring arm.
Professor Hwang said: “The omission of surgery has been highly controversial, and both patients and providers fear it could lead to an unacceptably high rate of patients developing invasive cancer.”
‘The important thing is to highlight that these are initial results.
‘While the results are provocative, I don’t think they are still practicing the change.
“For those patients who have already decided to refuse surgery, we have devised active monitoring that is safe.”
He also told the San Antonio Breast Cancer Symposium: ‘This was a select group of low-risk patients. We will first need follow-ups in five and ten years.
‘The active monitoring group would have had similar results if they had surgery.
“The small size of the invasive cancers that were detected is a sign that we are not delaying diagnosis in a way that is detrimental to patients.”
One in seven women in the UK are diagnosed with breast cancer in their lifetime (around 56,000 a year), making it the most common cancer in the UK.
The figure amounts to approximately 300,000 a year in the United States. About 85 percent of women diagnosed with breast cancer survive more than five years.