Stage Zero DCIS Breast Cancer and Biopsy

Breast self-exam
Breast self-exam

A new DCIS study is again raising doubts about conducting a biopsy if an older woman has a very early-stage type of breast cancer, and instead finds that the procedure is associated with side effects with little – if any – benefit.

The latest study from the Yale School of Public Health, found that sentinel lymph node biopsies (SLNB), which are often done on older women diagnosed with ductal carcinoma in situ (DCIS), — also known as “stage zero breast cancer” — didn’t reduce a woman’s likelihood of dying from breast cancer. The research also showed that the biopsy didn’t reduce the chances of developing invasive breast cancer and didn’t decrease the number of additional mastectomies. 

While the results indicate that conducting this type of biopsy in many of these women is likely futile – not to mention a waste of time and money – there were significant negative impacts from the procedure. Researchers found the biopsies increased a woman’s risk of side effects such as pain, wound infection and lymphedema. The last condition can be quite painful and can impede arm movement for the rest of her life.

The Yale researchers examined the health records of nearly 6,000 women with DCIS who underwent a lumpectomy, which is common after such a diagnosis. About 2,000 had undergone a SLNB, while the remaining women skipped the procedure.

The study is significant in that it is the first to assess the long-term impacts of a SLNB on a large number of older women. 

Although this is not the first study to show that DCIS is overtreated with unnecessary biopsies, between 17% and 40% of women with this type of early-stage breast cancer get a SLNB anyway.

A Patient-Centered Outcomes Research Institute (PCORI) funded study that was published last year found that compared to women diagnosed with DCIS who did not have an SLNB, those who did were more likely to experience short-term side effects such as swelling, infections, pain, and fluid under the skin where they’d had surgery. Over the long term, women who underwent an SLNB were more likely to have swelling up to 12 years after a DCIS diagnosis.

Current guidelines for treating DCIS call for a lumpectomy to remove cancerous tissue from the breast followed by radiation. However, a pair of ongoing studies may change that. The Comparing Operative to Monitoring and Endocrine Therapy for low-risk DCIS (COMET) trial seeks to compare invasive surgery, with or without radiation, to active surveillance, a “wait and see” approach. And the PREvent ductal Carcinoma In Situ Invasive Overtreatment Now (PRECISION) study is examining why breast cancer becomes invasive in some women diagnosed with DCIS but not others with the goal of curbing overtreatment of women with DCIS who are not at risk at more invasive disease.