If she had had her biopsy today, Redberg might have had another, albeit controversial, option: to simply monitor her cancer. Surveillance has long been considered an option for low-risk prostate cancer, and now researchers are exploring its use in other cancers, including papillary thyroid, which is, very often, so slow-growing that someone can fare well for years without it spreading.
Another is DCIS, Judy’s diagnosis. As mammography and other imaging has become more common and more sensitive, diagnoses of DCIS now make up as many as a quarter of breast cancer diagnoses. Previously, it was virtually unheard of.
The question is: how risky is it to leave those cells alone?
Since few women choose surveillance, research answers are limited. But a recent look back at patients treated in Boston proved encouraging. After ten years, over 98 percent of women hadn’t died from their low-grade DCIS, whether they had had surgery or not.
While the cancer outcomes are crucial, the impact on someone’s quality of life shouldn’t be ignored. Some women who choose surgery, radiation, and other measures for DCIS might struggle with related pain and recovery for some time, Hwang says. But without surgery, she counters, “there’s another flavor of misery where you’re just worried every day of your life that you’re going to get cancer”.
Hwang is leading the first large-scale randomized DCIS study in the USA, known as the COMET trial, which will analyze cancer rates as well as the psychological ripple effects. Psychological and quality-of-life aspects also are part of a similarly designed study called LORIS, which was launched in 2014 in the UK.
Prior research shows that women with DCIS harbor similar fears about recurrence and dying as those who have invasive breast cancer, despite DCIS being less serious. “We’ve got a lot of worry going on, and we don’t even know if the treatment that they’re receiving actually is of any value to them at all,” says Lesley Fallowfield, the principal investigator on the LORIS study’s quality-of-life assessment.
During discussions after her 2014 diagnosis, Judy’s doctors recommended a myriad of treatment approaches—mastectomy, lumpectomy, radiation, and tamoxifen—in various combinations to prevent the malignant cells from spreading. Finally, a surgeon suggested that Judy talk to doctors at the University of California, San Francisco, early proponents of monitoring as an alternative strategy. “He said, ‘They have a different view of DCIS than the rest of the world,’” Judy recalls.
As she mulled over her options, Judy worried about the risk of surgery and radiation, including short-term discomfort and possible longer-term side-effects. Plus, no one could guarantee her that the malignant breast cells would be eradicated for good. Do I want to live my life healthy and feeling good, she asked herself, or miserable and not feeling good, with the same outcome?