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What's In A Name?

In the case of cancer, it's everything. Nothing is more alarming to a woman than the discovery of a lump: prompt attention and evaluation is a great idea. What is equally alarming, undeservedly so, is a suspicious finding on a mammogram. One of the main drivers for the increased breast cancer diagnosis over recent decades has been improvements in mammography, allowing increased detection of suspicious lesions that summon forth a biopsy. The biopsy finds...well, something unusual. Identifying a few of its characteristics, and fearing the worst, physicians have called it "Ductal carcinoma in situ (DCIS)" which sounds a heck of a lot like cancer.

The lesion is removed, treatment for cancer is initiated, even including mastectomy in some cases. What has happened though is that despite aggressive treatment DCIS, the incidence and progression of legitimate and life-threatening cancers hasn't changed a bit. Zip. Stayed exactly the same from before we treated DCIS. Except a lot of women suffered surgery, chemotherapy, and an altered relationship with their own health and sense of mortality.

It is welcome news that the National Cancer Institute (NCI) has recognized the serious problem inherent in overdiagnosis. Tumors in other areas, notably the urinary bladder, have been recognized as pre-pre-cancerous and been renamed to lessen the alarm factor. The NCI recommends a similar re-branding of DCIS as well as increased efforts devoted to discerning which DCIS might become hazardous and which are truly best left alone. What we know at this point is initiating alarm and treatment at the point of DCIS has not resulted in improved morbidity and mortality related to invasive breast cancer.

Now, if the NCI would get serious about breast cancer prevention, we could truly applaud their efforts on behalf of women's health!