Watchful Waiting an Option for More Breast Cancer Patients

A recent study in the medical journal, "JAMA Oncology", is adding fuel to the argument that breast cancer is being over-diagnosed and over-treated.

Nearly 60,000 women a year are told they have DCIS, a non-invasive form of breast cancer.  Some patients are opting to watch and wait.

After a routine mammogram three years ago, 52-year-old Barbara Mann was diagnosed with "Ductal Carcinoma In-situ"… the earliest form of breast cancer.

"The initial reaction was, 'Get this out of my system'," Mann says.

DCIS accounts for up to 25-percent of breast cancers. mastectomies or lumpectomies have become standard treatments.

Surgeon Laura Esserman, the director of the Breast Care Center at UCSF is considered a pioneer of the "active surveillance" or "watchful waiting" treatment for breast cancer. She monitors patients with low-grade DCIS with screenings and medication for six months ...without surgery.

"Part of the personalization of medicine and breast cancer is not just to do more for those who need it but to do less for those that don't," Dr. Esserman says.

If DCIS shows little or no growth, patients can avoid more aggressive treatment..which has worked so far for Barbara. "It was just an immense relief," says Mann.

A study of more than 100,000 women with DCIS found aggressive treatments do not reduce breast cancer mortality rates. 

"When time is not of the essence, when it's not an emergency, you can offer different options," says Esserman.  "And see how the tumor behaves."

But the American Cancer Society says studies suggest about one-third or more of DCIS cases will progress to invasive cancer, if left untreated. The challenge is pinpointing which types of DCIS are most likely to worsen.

Kristin Orrantia's mother died from breast cancer. The 42 year old knew she was at high-risk when she was diagnosed with DCIS last June. She chose a double-mastectomy.
"I don't have to go in for the every six months, active surveillance, and have the worry and the anxiety and the stress of, 'Am I going to end up like my mom?'

Dr. Esserman's approach is controversial, but she hopes it will lead cancer treatment into a better future.. teri okita, for cbs news, san francisco.

Dr. Esserman says patients with DCIS should consider participating in clinical trials and registries to review their options. 40,000 women die of breast cancer each year.

(Teri Okita, CBS News)


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