Understanding Stage Zero Breast Cancer
- A new study published in JAMA Oncology is suggesting that some women diagnosed with stage zero breast cancer, known as ductal carcinoma in situ (DCIS), may not need treatment right away, and can instead take a watch-and-wait approach.
- Stage zero breast cancer refers to DCIS otherwise known as Ductal Carcinoma In Situ. DCIS are abnormal cells that line the duct in a breast. A normal breast comprises lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
- The COMET Randomized Clinical Trial is a large study that’s been looking into the benefit of active surveillance versus standard treatment.
- This type of research has been put into place to help doctors decide whether doing less may be as effective as doing more. In the meantime, the options are worth weighing depending on your diagnosis and concerns.
- Remember, when something doesn’t feel right, talk to your doctor and always get a second opinion if you’re not getting answers; you need to be your biggest advocate regarding your health.
As hundreds of thousands of women like “Boy Meets World” actress Danielle Fishel, 43, have been overtreated for early-stage breast cancer—a new study published in JAMA Oncology, is saying that treatment for the disease is actually no better than active surveillance after a stage zero diagnosis.
Read MoreAn Overview of Breast Cancer Treatment
This type of research has been put into place to help doctors decide whether doing less may be just as effective as doing more. In the meantime, the options are worth weighing depending on your individual diagnosis and concerns.
For this prospective randomized clinical trial of 957 participants, study authors concluded that “active monitoring is not inferior to guideline-concordant care,” adding, “These data support the short-term safety of active monitoring compared with guideline-concordant care in patients with low-risk ductal carcinoma in situ.”
“Women with low-risk DCIS randomized to active monitoring did not have a higher rate of invasive cancer in the same breast at 2 years compared with those randomized to guideline-concordant care,” the authors concluded.
We understand that these findings can be distressing to women who have already undergone surgery, chemotherapy, and/or radiation for early-stage breast cancer, it’s important to note that approximately 30 percent of women who initially receive an early-stage breast cancer diagnosis will end up developing metastatic breast cancer, according to the National Breast Cancer Foundation.
Additionally, Breast Cancer Research Foundation reports that women with stage zero breast cancer have a a high success rate of beating the disease, with a 98 percent survival rate after 10 years.
The study participants involved 950 women who were ages 40 and older with a low-risk DCIS that was hormone receptor–positive, grade 1 or grade 2 breast ductal carcinoma in situ. The findings were obtained after half of the women were recommend surgery with or without radiation and the other group, bi-annual mammograms, with the option to get surgery if the cancer developed.
Helping Patients Cope with Early-Stage Breast Cancer
- Hope For Some Early-Stage Breast Cancer Patients: Verzenio
- Introduction to Early-Stage Breast Cancer
- Early Stage Breast Cancer: What to Know About Testing
- Updated Guidelines on Biomarkers for Early-Stage Breast Cancer
- I Have Stage Zero Breast Cancer: What Should I Do?
- Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
- How Does Molecular Testing Help Determine the Best Breast Cancer Treatment Option?
- Surgery or Chemo First? How is Breast Cancer Treatment Order Determined
Dr. Partridge explained to SurvivorNet that stage zero breast cancer is, “Something that may turn into invasive breast cancer. Invasive breast cancer is the kind of breast cancer that has the potential to not only grow in your breast but to spread to other places in the body and ultimately hurt someone more than just needing a breast surgery.”
The current standard of care is treatment with either lumpectomy or mastectomy, radiation, and hormonal therapy.
Additionally, Dr. Chirag Shah, Director of Breast Radiation Oncology at the Cleveland Clinic Cancer Center, says recent studies show that the risk of dying from stage zero breast cancer is very low, prompting some doctors to opt for less aggressive treatment and, even in some cases, active surveillance.
“Protocols, such as the comet trial, are studying the use of surveillance regimens, but this is not standard of care and is experimental at this time, and active surveillance is not something that we would recommend for patients outside of a clinical study,” Dr. Shah said.
RELATED: Access to Good Information is Crucial After a Breast Cancer Diagnosis
Dr. Alana Welm, of the Huntsman Cancer Institute, also told SurvivorNet that doctors need to find a balance between screening and finding cancers that actually require treatment.
Finding a Balance Between Screening and Treating
Screenings lead to more people being diagnosed with cancer, and some of those cancers may have never caused an issue. Dr. Welm says treating these cancers exposes patients to unnecessary toxicities. Stage zero breast cancer, for example, can get picked up during screening but not all doctors see eye-to-eye on whether it requires treatment or just monitoring.
Meanwhile, internationally recognized breast surgeon and breast oncology specialist Dr. Laura Esserman, who conducted the COMET study to look at the benefit of active surveillance versus standard treatment for stage zero breast cancer, previously offered SurvivorNet some additional insight on this matter.
I Have Stage Zero Breast Cancer: What Should I Do?
Dr. Esserman told SurvivorNet a few months back, “Surgery is standard of care for DCIS. Chemotherapy is never recommended for treatment of DCIS. The COMET study, for which we eagerly await the results, is a landmark effort to transform our approach and test the idea of active surveillance.
“We have just launched an exciting new study to test new approaches to risk reduction in DCIS. The RECAST DCIS (Re-evaluating Conditions for Active Surveillance suitable as Therapy for DCIS) will start with a non-operative approach.”
She continued, “Everyone can start with six months of surveillance and we used MRI imaging features to determine who is a good candidate to continue surveillance and avoid surgery. DCIS is a window of opportunity to rethink prevention.”
Should I Have a Lumpectomy or Mastectomy?
Additionally, she and another co-author for the study Dr. Kelly Hewitt, recently explained in The ASCO Post, “The trial randomly assigned patients with low- to intermediate-grade hormone receptor–positive DCIS to standard-of-care treatment or active surveillance, with or without the addition of endocrine therapy. If we can identify those patients who are at low risk for disease progression, we can, hopefully, save them from unnecessary and aggressive treatments. ”
It’s important to understand that this study will help doctors determine whether less treatment may be just as effective as doing more. Of course, the options are worth weighing depending on your individual diagnosis and concerns.
Dr. Hwang told the Breast Cancer Research Foundation (BCRF) earlier this year, “The COMET trial is a prospective randomized trial, and one group of patients are monitored very closely. And in the other group, they undergo surgery right away just as we would do for anyone else who’s diagnosed with DCIS. And then we follow them over the course of the next five to 10 years, and we have successfully recruited almost a thousand women, so 997 women who randomized as of January of 2023.
“So now we’re really excited to wait for the results of the study, which should be able to publish and report out in the next 12 months or so, and we’ll do an early look to see if it’s safe to keep patients on close surveillance rather than operating on them right away. And I think in the future as even better treatments evolve, those are the things that we want to offer to patients with low-risk DCIS including things like DCIS vaccines, which would really reduce the need for these patients to get surgery.”
Dr. Chirag Shah On The Debates Surrounding Radiation Treatments For Breast Cancer
Stage Zero Breast Cancer
Stage zero breast cancer refers to Ductal Carcinoma In Situ (DCIS). DCIS are abnormal cells that line the duct in a breast. A normal breast is made up of lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
Learning About Stage Zero Breast Cancer (DCIS)
DCIS is not an invasive cancer, meaning it hasn’t spread outside the milk duct and it cannot invade other parts of the breast. In some instances, if left untreated, doctors believe that DCIS can evolve into a more invasive breast cancer. This is why historically, the standard treatment for DCIS is to remove it surgically and in some instances offer radiation as well.
However, many doctors aren’t sure if even that is necessary for DCIS, because it may or may not turn into cancer.
And in an effort to reduce the fear around the earliest stage breast cancer we want you to understand the definition and the debate around treatment.
Two important facts about DCIS breast cancer are:
- It doesn’t spread to other parts of the body.
- The risk of death is essentially zero.
RELATED: Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
As for the debate, some doctors don’t consider it cancer, but rather a collection of abnormal cells or a pre-cancer, which is why some women opt for a watch-and-wait approach.
Others may recommend the surgery route which usually involves a lumpectomy and potentially radiation as well. This somewhat more aggressive treatment (which is the standard protocol at major cancer centers) does have side effects, and potentially, long-term effects.
Dr. Elizabeth Comen Explains The Main Aspects Of Early-stage Breast Cancer
Less commonly, doctors and their patients will decide on more aggressive approaches depending on the amount of DCIS in the breast and a woman’s specific risk factors for future breast cancer. One reason some doctors may want to remove DCIS is if a biopsy reveals any evidence that a more invasive breast cancer could be present.
Deciding the Right Course of Breast Cancer Treatment
Doctors treating breast cancer seek out markers on your particular cancer to help decide what course of treatment is best for you. This is due to the cancer cells possibly having what are known as receptors that help identify the unique features of the cancer.
The three main receptors are the estrogen receptor, the progesterone receptor, and the HER2 receptor. The estrogen and progesterone receptors go together because they are fueled by hormones. Think of the cancer cell as having little hands on the outside of the cell which grabs hold of proteins that help it grow. These proteins are sometimes called “ligands.”
An example of a type of ligand that can stimulate a cancer cell is the hormone estrogen. An estrogen receptor-positive breast cancer will be stimulated by estrogen to grow. In this instance, your doctor may offer you treatment to specifically target the estrogen receptor.
The Unique Features of Breast Cancer
Another important receptor to test for is the HER2 receptor. For HER2 positive breast cancers, therapies that uniquely target the HER2 receptor are essential to treating the disease.
Danielle Fishel’s Cancer Journey
Danielle Fishel, best known for her role as “Topanga” on the ‘90s sitcom “Boy Meets World” a lumpectomy and a margin revision surgery after being diagnosed with early stage breast cancer this year.
Fishel admitted she was initially hesitant to share her diagnosis publicly but felt by doing so; she could help many other women cope with a breast cancer diagnosis.
“It’s technically stage zero. To be specific, I was diagnosed with high-grade DCIS (ductal carcinoma in situ) with micro-invasion,” Fishel said on the Pod Meets World podcast, which she and co-stars Rider Strong and Will Friedle hosts while reliving classic episodes.
View this post on Instagram
Fishel, a mother of two, added that the cancer has been caught in its early stages, and explained further, “I’m going to be fine. I’m having surgery to remove it. I’m going to be on some follow-up treatment. I’ve had to make a lot of decisions over the last couple of days.”
She also shared that she felt if she were ever to be diagnosed with cancer, she would have to “suffer in silence” and only tell a small group of people until she’s beat the disease and then share details more openly.
However, the actress noted her change of heart. “What I realized is the more people I talk to, the more people had their own experiences, either themselves being diagnosed with cancer or a family member who’s been diagnosed with cancer,” Fishel said.
She is grateful her annual mammogram helped her detect the cancer before it had a chance to mature.
“If it’s time for your appointment, if you’ve never had an appointment before, get in there. If you have to find out that you have cancer, find out when it’s at stage zero, if possible,” Fishel said.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
