When is it right to have invasive procedures for non-invasive cancers?

Prof Sir Mike Richards, the "Cancer Czar"

Since the announcement by Professor Sir Mike Richards – the National Clinical Director for Cancer (more commonly known as the "Cancer Czar") – that he has set up an independent review of the breast screening service, I have read, watched and listened to news bulletins about the subject and found them all to be totally confusing and, in some cases, less than accurate.

The central issue seems to be DCIS (ductal carcinoma in situ), which was described by one television broadcaster as being a "pre-cancerous" condition and, by another, as being treated unnecessarily with chemotherapy. Neither of these statements is correct.

To make sure I understood the condition, I spoke to Dr Emma Pennery from Breast Cancer Care. Emma explained to me that the crux of the matter is that DCIS is a type of non-invasive breast cancer which might or might not develop into an invasive cancer. It is definitely not a pre-cancerous condition.

However, as yet, we do not have the technology to determine which DCIS will invade and which will remain in the breast duct – therefore it is not possible to decide which woman is safe with the tumour left in her breast and which is not.

So, at the moment, the policy is to surgically remove the cancer and follow with radiotherapy. Chemotherapy is never used for this condition because the cancer cells have not escaped: they remain in the breast duct and do not need to be mopped up.

For some women diagnosed with this condition, who have undergone disfiguring surgery and treatment, the discovery that the cancer might not have developed in their lifetime has proved difficult to bear, and induced much anger. This is the "over-diagnosis" and "over-treatment" of which we have read and heard.

I can understand how these women feel but, having experienced breast cancer, I find it hard to imagine leaving the tumour in place and waiting to see what happened. I would be too anxious knowing there was a cancerous tumour lurking in my breast and would think "better safe than sorry" – but other women are happier going forward with a 50 per cent chance that all will be well. There is, of course, no right or wrong reaction – we are all different, entitled to our own opinions and should not be afraid to refuse treatment or mammography if that is our wish.

We know that mammograms are not 100 per cent accurate – nothing is. False negatives and false positives do occur and surgery may be carried out only to find that the condition is benign (again, for me "better safe than sorry") – but, for the vast majority of people, these tests provide a great service in detecting tumours before they are "feel-able" or "see-able" and, as we all know, if a cancer is caught early the outcome is much more likely to be positive.

Let us hope that it will not be too long before researchers find a method of testing DCIS and establishing which will remain in place and which will spread.

Meanwhile, if you feel you need more information before you make a decision about having a mammogram or surgery, please contact Breast Cancer Care whose nurses will talk you through all the advantages and disadvantages of screening, surgery and treatment plus guiding you through the myriad of different breast cancers.

It is imperative that when women and men make decisions about their health problems – particularly where cancer is concerned – these decisions must be well-informed.

www.breastcancercare.org.uk

Telephone 0845 092 0800

Email: info@breastcanceercare.org.uk