The only time I'd really seen my surgeon flummoxed was when I referred a mutual acquaintance who was diagnosed with what's often called 'early breast cancer.' The term means different things to many people. For the woman newly diagnosed the operative word may be cancer; for those who've been successfully treated congratulations may seem in order (YayYouDon'tNeedChemo); for women with aggressive or metastatic cancer it's the disease they wish they had.
"Is she a friend of yours," my surgeon stated, not asking. This was his not-so-subtle way of fishing asking for more information. "No," I told him in all honesty, "she came in under the transom."
This happens in any community once you've had cancer and are here to tell about it. You automatically become an informal source of information on cancer, doctors, treatments, facilities, and how to cope with everything from infection to nausea to dizziness, and whether or not homeopathy, Dr. Mercola or Dr. Oz are good sources of information.
I later found out what stumped my surgeon. The woman's 'early breast cancer' was in fact DCIS - ductal carcinoma in situ or Stage 0 cancer - and she wanted a double mastectomy so she wouldn't ever have to think about breast cancer again. Period. He thought a mastectomy, not to mention a double mastectomy, was like dropping an atomic bomb on an ant. This isn't a story of right or wrong, but an indication of how times have changed in seven years and how, at long last, a technology is now available that can predict when DCIS is more likely to recur.
Results from a clinical validation study released at the San Antonio Breast Cancer Symposium yesterday represent a great step forward in the treatment of ductal carcinoma in situ, which affects up to 45,000 women every year. To date there haven't been any validated molecular markers to select those patients with a high risk of recurrence.
According to a news release issued by the American Association for Cancer Research, this is the first time a multigene test has been used to differentiate the aggressive forms of DCIS that require radiation, from lower risk disease.
The study, conducted by the Eastern Cooperative Oncology Group, validated the use of OncotypeDX in patients previously enrolled in a prior study (E5194) of breast conservation surgery. It clearly identified up to 75% of patients over a ten-year period who were at a low risk for recurrence and could consequently, forgo radiation therapy without any differences in overall survival.
"This is a big step forward in terms of treating women with DCIS," said Deanna Attai, MD, director, Center for Breast Care in Burbank, California. "With both invasive and non-invasive breast cancer, it is clear that some women are over-treated, and unfortunately we are also not always accurate in identifying which women have more aggressive disease requiring more aggressive treatment. The ability to really identify a cancer's biologic behavior, "what makes it tick" is going to help us be more selective in our therapy, sparing many women toxic treatment that will be of little or no benefit, and identifying women at higher risk of recurrence that should undergo more aggressive, and hopefully more targeted therapy."
Biology, not pathology, is what ultimately determines the kind of treatment required. How a sample of tissue from a tumor looks under a microscope, said the American Cancer Society's Chief Medical Officer Otis Brawley, MD, in a recent NY Times article, "does not always predict."
Bingo. That's the million dollar question. How cancer looks under the microscope may not be the true story of what it does in your body. My cancer may be napping while yours is out to paint the town. Or vice versa.
The test will be available for women diagnosed with DCIS by the end of this year, "If we can spare a woman from having to undergo adjuvant therapies then we can actually reduce overall cost when the test is used correctly. The majority of patients are lower risk," said Lawrence Solin, MD, lead investigator.
At long last, the beginning of technology to help assist women with "weird cells" and how to help them decide other than repeating the oft-told tale of someone's Aunt Minnie. Real data, for women who need it.
# # #
"Is she a friend of yours," my surgeon stated, not asking. This was his not-so-subtle way of fishing asking for more information. "No," I told him in all honesty, "she came in under the transom."
This happens in any community once you've had cancer and are here to tell about it. You automatically become an informal source of information on cancer, doctors, treatments, facilities, and how to cope with everything from infection to nausea to dizziness, and whether or not homeopathy, Dr. Mercola or Dr. Oz are good sources of information.
I later found out what stumped my surgeon. The woman's 'early breast cancer' was in fact DCIS - ductal carcinoma in situ or Stage 0 cancer - and she wanted a double mastectomy so she wouldn't ever have to think about breast cancer again. Period. He thought a mastectomy, not to mention a double mastectomy, was like dropping an atomic bomb on an ant. This isn't a story of right or wrong, but an indication of how times have changed in seven years and how, at long last, a technology is now available that can predict when DCIS is more likely to recur.
Results from a clinical validation study released at the San Antonio Breast Cancer Symposium yesterday represent a great step forward in the treatment of ductal carcinoma in situ, which affects up to 45,000 women every year. To date there haven't been any validated molecular markers to select those patients with a high risk of recurrence.
According to a news release issued by the American Association for Cancer Research, this is the first time a multigene test has been used to differentiate the aggressive forms of DCIS that require radiation, from lower risk disease.
The study, conducted by the Eastern Cooperative Oncology Group, validated the use of OncotypeDX in patients previously enrolled in a prior study (E5194) of breast conservation surgery. It clearly identified up to 75% of patients over a ten-year period who were at a low risk for recurrence and could consequently, forgo radiation therapy without any differences in overall survival.
"This is a big step forward in terms of treating women with DCIS," said Deanna Attai, MD, director, Center for Breast Care in Burbank, California. "With both invasive and non-invasive breast cancer, it is clear that some women are over-treated, and unfortunately we are also not always accurate in identifying which women have more aggressive disease requiring more aggressive treatment. The ability to really identify a cancer's biologic behavior, "what makes it tick" is going to help us be more selective in our therapy, sparing many women toxic treatment that will be of little or no benefit, and identifying women at higher risk of recurrence that should undergo more aggressive, and hopefully more targeted therapy."
Biology, not pathology, is what ultimately determines the kind of treatment required. How a sample of tissue from a tumor looks under a microscope, said the American Cancer Society's Chief Medical Officer Otis Brawley, MD, in a recent NY Times article, "does not always predict."
Bingo. That's the million dollar question. How cancer looks under the microscope may not be the true story of what it does in your body. My cancer may be napping while yours is out to paint the town. Or vice versa.
The test will be available for women diagnosed with DCIS by the end of this year, "If we can spare a woman from having to undergo adjuvant therapies then we can actually reduce overall cost when the test is used correctly. The majority of patients are lower risk," said Lawrence Solin, MD, lead investigator.
At long last, the beginning of technology to help assist women with "weird cells" and how to help them decide other than repeating the oft-told tale of someone's Aunt Minnie. Real data, for women who need it.
# # #
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