When mammograms were first established, the goal of the screening was to be an effective way to detect breast cancer at an earlier and more curable stage. The idea was if this screening tool could increase the detection of cancer at an earlier stage, then naturally there would be a decrease in the detection of cancer at a late stage.

This is not at all what we have seen over the past 20+ years.

Surly early stage detection shot up, but late stage detection didn’t show any noteworthy growth. How could this be? If mammograms are catching early stage cancers shouldn’t there be a less likely case that a woman would be seeing late stage cancer as well?

You would think so, but here is the culprit behind the confusion: there is an overdiagnosis in early stage cancers. It’s possible a woman would have had no idea or ever be harmed by these detections, in fact there’s potential that the cancer would have gone away on it’s own!

The problem: a mammogram is unable to determine the difference between fatal and harmless cancer.

The way the process has gone over the years is if a mammogram finds anything, you treat it. However, this can get rather dicey when it comes to Ductal Carcinoma In Situ (DCIS) also known as “stage 0” cancer. DCIS are cancerous cells that are within the ducts and in position to become a mass, but haven’t become one yet.

The overdiagnosis of early stage cancer

At first, DCIS accounted for 3% of the cancers detected during a mammogram. However as time has gone on, DCIS now accounts for 20%-25% of cancers found. The problem is DCIS looks like invasive cancer, both pathologically and molecularly. Therefore it’s been recommended for it to be removed time and time again because it’s categorized as “the precursor” for cancer. But we don’t even know what it’s going to do yet! The staggering evidence to this overdiagnosis is the 50k-60k DCIS lesions that happen annually have not reduced the incidence of invasive breast cancers.

Basically, even if a woman opts to remove the DCIS, it doesn’t mean she’s been spared from invasive cancer. These lesions have nothing to do with invasive cancer showing up at another time because many times, the two are unrelated.

Experts will say the problems lies in the overtreatment not the overdiagnosis

They argue that women have been over treated for their detections rather than over diagnosed for what is found. However, over a 10 year span 98.8% of women died not having DCIS removed, while 98.6% still passed away having the surgical excision.

With this being said, there’s really no correlation with surviving breast cancer vs. not whether or not you surgically remove DCIS.

Watch Video: “Overtreatment of Stage 0 Breast Cancer”

What exactly is being proposed here?

The real question is, how do you not get someone to panic when they are told they have something that could maybe turn into cancer (or not)? Rightfully so, cancer scares people. They become paralyzed when there’s any association with cancer and their bodies. The immediate response from most is survival mode; get this out of me!

One idea that’s been proposed is to change the name of DCIS, to not include the word “carcinoma” in the name, since we don’t know if it will ever drastically become aggressive cancer.

Another suggestion is just for women to stop scheduling annual breast cancer mammograms. Why subject yourself to the possibility of DCIS detection and allowing yourself to go through the many invasive treatments when there’s a great possibility that the DCIS wasn’t ever going to harm you in the first place? Instead of annual screenings, do what you can in everyday life. Change your diet to be more healthy, drink less alcohol, exercise regularly, the list goes on!

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