New Study Shows the Effectiveness of Mammograms in Detecting Second Breast Cancers in DCIS Patients
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A recent study, published December 28, 2023, sheds new light on how effectively mammograms identify second breast cancers among women with a history of ductal carcinoma in situ (DCIS), an early stage of breast cancer. Over the study’s 10-year follow-up period, routine clinical examinations detected 2.2 percent of second breast cancers. Meanwhile, just over 20 percent were detected by patients themselves, and mammograms found 73.7 percent of second breast cancers.
Who Gets DCIS?
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- Older age
- Family history of breast cancer
- Certain genetic mutations
- Previous breast disease
- Never being pregnant
- Hormone-related factors like an early start to menstruation or a later start to menopause.
- If you are diagnosed with DCIS at a younger age, your risk of developing invasive breast cancer is higher.
- Among its findings, this recent study showed that Black women who had DCIS were more likely to experience a second cancer.
- Women whose DCIS involved larger areas or had higher DCIS grades were more likely to experience a recurrence or progression to invasive breast cancer.
- Women who did not get radiation therapy for their DCIS were more likely to experience a recurrence.
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What Do These Findings Mean for Women With DCIS?
This recent study suggests that a stronger emphasis on educating patients to conduct self-examinations might be necessary. It also questions the efficacy of clinical breast exams in detecting these cancers when they recur.
According to Tari A. King, MD, the chief of breast surgery at Dana-Farber Brigham Cancer Center in Boston, “This study’s findings support current guidelines, with the caveat that educating patients on self-awareness of their breasts is important. [I]f a woman notes a change, having a [recent] normal mammogram should not dissuade her from bringing that change to the attention of her physician. [They also] clearly demonstrate the importance of patients being familiar with and aware of changes in their breasts, and they also need to be comfortable bringing these changes to their providers’ attention.”
Dr. King says this study shows that mammography continues to be the most common method for diagnosing DCIS. Ninety-eight percent of patients in the study had their initial diagnosis of DCIS made by mammography, and 99 percent of patients who had recurrent disease detected on imaging had their diagnosis made by mammogram.
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King remains in favor of the guidelines as they are. “I support these guidelines for patients with DCIS who have received standard therapy to include surgery with or without radiation therapy. Although the authors suggest that clinical breast examinations may be less relevant, [these exams are] an opportunity to teach patients how to examine their own breasts and to educate them on what is normal and not normal.”
Irene Wapnir, MD, a surgical oncologist and breast specialist at Stanford Medicine in Palo Alto, California, agrees. “The other question is what kind of emotional reassurance do patients need in their follow-up?” she says. “Especially those who have conserved their breast.” A clinical breast exam, especially one done by a breast specialist, could offer patients peace of mind that they’re doing self-exams correctly and aren’t missing signs of a recurrence. “If you think you don’t feel anything in your breast but someone else reconfirms it, that may have some value.”
According to Dr. Wapnir, “What [the study authors] are saying is that the likelihood of a physical finding is low in this patient population, which is good news. The question is, if you ratchet down the clinical follow-up, what are you ratcheting it down to? I think [the study’s] value, its strength, is that it’s a real-world analysis of activity and surveillance rather than what academic centers publish. It’s thought-provoking, it’s interesting, but it leaves some questions unanswered.”
How Is DCIS Treated?
Breast-Conserving Surgery This procedure involves removing the tumor or area of malignant microcalcifications and a small amount of surrounding breast tissue. Usually, surgeons do not need to remove lymph nodes unless they find invasive cancer. After surgery, research shows that radiation therapy helps lower the chance of DCIS’s return.
Mastectomy During this procedure, a surgeon removes the entire breast. Mastectomy might be necessary for large areas of DCIS or if breast-conserving surgery cannot or did not remove all the cancer. You may not need radiation after a mastectomy for DCIS.
Hormone Therapy After Breast Surgery If your DCIS is hormone receptor–positive, your care team might prescribe hormone therapy with medications like tamoxifen or aromatase inhibitors for five years after surgery. This helps lower the risk that DCIS will recur, or that invasive cancer will develop. Discuss the pros and cons of hormone therapy with your doctor if you have hormone receptor–positive DCIS.
Follow-Up Care: How and How Often Should I Get Screened?
The recent study’s authors suggest telehealth can be an effective alternative for monitoring DCIS survivors, with an in-person exam for someone who reports symptoms or has abnormal imaging results. They point out it can save time and money, and increase access for people who don’t have nearby healthcare options. But they also emphasize the importance of annual mammograms and education about self-detection.
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The NCCN guidelines apply generally, and your specific circumstance may be different. For example, King points out, “Patients who choose non-operative management for DCIS may need more intensive surveillance — more frequent mammography — and patients with an inherited predisposition to cancer may also benefit from enhanced surveillance with MRI screening.”
Ultimately, you should do what your doctor recommends. People who have been treated for DCIS should stick to the recommended annual mammogram and get examined by a medical practitioner with expertise in breast health at least once each year. But you should also perform regular self-exams and communicate any changes to your care team.
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