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.
After a routine mammogram three years ago, 52-year-old Barbara Mann was diagnosed with ductal carcinoma in situ (DCIS), the earliest form of breast cancer.
"The initial reaction was, get this out of my system," said Mann.
DCIS accounts for up to 25 percent of breast cancers, mastectomies or lumpectomies have become standard treatments.
Surgeon Laura Esserman, UCSF Breast Care Center director, 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," said Esserman.
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," said 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 and see how the tumor behaves," said Esserman.
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 Orrantias 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," said Orrantia.
Esserman's approach is controversial but she hopes it will lead cancer treatment into a better future.
Esserman says patients with DCIS should consider participating in clinical trials and registries to review their options.
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