Now accounting for approximately 20% of newly diagnosed breast cancer1, Ductal Carcinoma in Situ pertains to the abnormal cells within the milk ducts. It has not spread outside of the milk ducts and therefore is considered non-invasive. Many oncologists refer to it as stage 0 breast cancer. You may not feel anything, like a lump, but it can be detected on a mammogram as suspicious, abnormal branching or linear calcifications. DCIS is diagnosed by doing a biopsy of the tissue. Once diagnosed a patient is scheduled to see a breast cancer surgeon, a plastic surgeon, a radiation oncologist and a medical oncologist, and many times the patients are able to see each doctor all on the same day.2
DCIS was basically unknown until the introduction of screening mammography in the 1980s, and there is increasing evidence that it is being overdiagnosed (and thus overtreated). In 1995 the British medical journal The Lancet reported that, “since mammographic screening was introduced in 1983, the incidence of ductal carcinoma in situ (DCIS), which represents 12% of all breast cancer cases, has increased by 328%, and 200% of this increase is due to the use of mammography. This increase is for all women: Since the inception of widespread mammographic screening, the increase for women under the age of 40 has gone up over 3000%.3”
But if DCIS is considered stage 0, is it really cancer, and is it necessary to pursue all these conventional treatment options as if it were an early-stage breast cancer? Many cancer authorities would answer “no” to both questions, according to cancer nutritionist Mark Nathaniel Mead MSc, who serves as a consultant to several integrative medicine clinics in North Carolina. “The emerging consensus is that DCIS is a non-obligate precursor to breast cancer, meaning that it may or may not become cancer, and thus calling it cancer in the first place is misleading,” says Mead, who recently lectured at the 2019 annual scientific conference for the American Academy of Thermology. “Based on the best available evidence, only about one out of every three DCIS cases will eventually turn into invasive breast cancer, and most of those invasive cases will never become aggressive or life-threatening.”
In short, it appears that many cases of DCIS are being treated in an overly aggressive manner. Even surgery may not be necessary in some cases. Mead says that 98% of DCIS is treated surgically, either with a mastectomy or with some form of breast-conserving surgery (lumpectomy or wide local excision). Published research indicates that the risk of a recurrence in the same breast is only about 40 percent in the next 20 years after surgery is performed. About half those recurrences will be DCIS; the other half will be invasive breast cancer. The risk of recurrence is higher with an initial diagnosis of grade 3 DCIS (as opposed to grade 1 or 2).
3 Grades of DCIS
Three major randomized clinical trials are now under way to establish whether women with low-grade DCIS may be better off without surgery. By at least being able to postpone surgery, these women would avoid all the risks and complications associated with surgery, radiation and other conventional treatments. For example, women who undergo radiation after surgery are at significant risk of heart disease and various life-threatening cancers. By postponing surgery, they would avoid all these risks, as well as all the stress and anxiety that often accompanies such treatment.
Some leading breast cancer experts have proposed that women with low-risk DCIS (low grade, estrogen positive, favorable family history) may avoid surgery and instead get monitored with regular mammograms. This approach is known as “active surveillance.” But if a woman diagnosed with low-risk DCIS is known to already have abnormal cells, why would she want to expose those abnormal cells to ionizing radiation from a mammogram, at the risk of making those cells more aggressive and more likely to turn into invasive disease?
Instead of relying solely on screening mammography for women with low-risk DCIS, the use of breast thermography may prove useful and could help reduce the need for mammograms. Thermography is a screening tool that can detect changes in the breast tissue by providing accurate and reproducible images of the breast without the use of radiation and compression. The screening device is approved by the FDA and is a much safer way to monitor these women with already abnormal cells. There is a huge role that thermography can play in detecting the progression of DCIS into IBC (invasive breast cancer). A woman can be monitored as often as four times a year and there would be no exposures to any sort of radiation or compression. This type of screening is especially useful for women who have dense breasts. Mead’s literature reviews and research brings up the discussion on the sensitivity of mammography in women with DCIS and high breast density.
In Mead’s recent presentation for the American Academy of Thermology in Atlanta, he suggested that thermography could play a valuable role in monitoring DCIS cases in the future. “The sensitivity of mammography is currently about 70-90% in postmenopausal women, but only about 40-50% in younger women and those with dense breasts,” Mead says. “That’s a really big problem, since about half of all women have dense breasts. The good news is that breast thermography, when properly performed, now consistently shows a sensitivity of 97-100% even in women with very dense breasts. This level of sensitivity is at least twice as high as that of digital mammography, so we definitely need to reevaluate our screening practices.”
As mentioned before, an active surveillance program would be of interest to women with lower risk factors. For instance, The US Preventative Services Task Force (USPSTF) currently does not recommend routine screening for women in their 40s, but rather recommends a discussion of the risks and benefits.4 In this age group, the chance of absolute benefit is lowest and the chance of false-positives highest.4 The available data suggest that in making screening recommendations based on and individual’s risk profile, overdiagnosis can be minimized and the potential benefit will be maximized.
Within a patient’s risk profile, metabolic trends seen in blood work can also be useful because it is non-invasive and also reproducible. Testing a comprehensive blood test along with cancer markers such as CA27.29, CA15-3, and LASA as well as heavy metal testing, can determine a patient’s health status at a metabolic level. Deficiencies, toxicities, immune function, hormone balance, and inflammation can all be seen in the blood. Placing patients on personalized supplement protocols and dietary guidelines based on their comprehensive testing results monitoring changes seen in the blood will benefit the patient’s overall health. Preventing DCIS turning into invasive cancer, or even just slowing it down, is the goal when speaking of an “active surveillance program”.
Blood testing and heavy metal testing can be done at any age. It is never too late to start. You may even be surprised at findings that can be detected on comprehensive blood panels that go above and beyond what your primary doctor is testing. Wouldn’t it be useful to note that your diabetic marker is going up before you become diabetic? Instead of waiting until a diagnosis is made, be preventive, be proactive, and be educated about your health. Set up your appointment today to discuss benefits of blood testing and heavy metal testing to see where you need to make changes in your lifestyle and start your “active surveillance program”!
- Armed Forces Health Surveillance Center. Incident diagnoses of breast cancer, active component service women, U.S. Armed Forces, 2000- 2012. MSMR 2013; 20:25–27
- Koty, Patrick P. “Breast Cancer Prevention by Inducing Apoptosis in DCIS Using Breast Ductal Lavage.” 2005, doi:10.21236/ada443722.
- Sanders ME, Schuyler PA, Dupont WD, Page DL. The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer 2005;103:2481–2484.
- Mandelblatt JS, Cronin KA, Bailey S, et al. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 2009;151:738–747.