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I note that the San Antonio Breast Cancer Symposium (SABCS) has been debating the management of DCIS. I wish I was with you, I used to go every year and once was awarded the William McGuire lectureship, a great honour. Here are a few thoughts on this topic./1
DCIS can be considered an "iatrogenic" pathology that became an epidemic with the launch of population screening.
Before screening its incidence was <1.0% with screening it shot up 20%. It was assumed that as a result we would see a fall in early invasive disease./2
Before screening its incidence was <1.0% with screening it shot up 20%. It was assumed that as a result we would see a fall in early invasive disease./2
Well we didn't - the incidence of T1 invasive cancer also went up. OK but at least "catching it early" and that would reduce the mastectomy rates in the population. Well it didn't because DCIS is often multifocal and the mastectomy rate went up as well./3
Well at least screening saves lives. Sorry to say but this is a false promise because for every breast cancer death avoided that is one death from the toxicity of the treatment of cases over-diagnosed. See decision aid attached./4
The answer to DCIS is "prevention" and however counter-intuitive the best way of "preventing" DCIS is to stop screening and use these scarce resources for research on prevention and treatment. /end
