Early Detection and Avoiding Overtreatment

One of the most important issues in breast cancer treatment is whether non-invasive breast cancers found with screening mammograms should be treated in the same manner as invasive breast cancer.  At this point, we frankly don’t know which small tumors found on mammograms, called ductal carcinoma in situ (or DCIS), will progress to invasive and metastatic forms of breast cancer and which might resolve themselves without medical intervention.

It’s a big question, and there are valid concerns about over-diagnosis and overtreatment of DCIS.  Left untreated, about 20 to 30 percent of low grade DCIS will progress to invasive breast cancer.  But we can’t tell yet which tumors will actually progress, so DCIS is treated  – with surgery and radiation – and sometimes systemic therapy because most women and their doctors aren’t willing to leave them to chance. More information on DCIS and recommended treatments.

This potential for overtreatment has been a huge concern at Susan G. Komen for the Cure, which is why we’ve invested more than $9 million into research to bring scientific certainty to this critical question.  We were very pleased this week to see progress from our research grantees at Thomas Jefferson Cancer Center in Philadelphia, working with researchers at the University of Texas Southwestern, to identify genetic patterns involved in “turning on” or “turning off” the progression of cancer. Their findings could eventually lead to a genetic test to help doctors and women decide whether aggressive treatment for DCIS is warranted (Los Angeles Times report on this study).

While more study is certainly needed, these recent findings are exciting because they will lead to better, more personalized treatment for more than 50,000 women estimated to be diagnosed with DCIS each year. This should allow some to avoid aggressive treatment entirely, while appropriately treating women at higher risk.

This research resulted from a Komen Career Catalyst Grant awarded in 2008 to Dr. Agnieszka Witkiewicz.  It is just part of our $30 million investment into early detection research, aimed at finding more sensitive, cost-effective and convenient screening methodologies, and more accurately determining which tumors may progress and which won’t.

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