Celebrity Danielle Fishel raises awareness of ductal carcinoma in situ
Danielle Fishel, who played Topanga Lawrence on the television sitcom, Boy Meets World, announced in August that she was diagnosed with ductal carcinoma in situ (DCIS), which is also referred to as stage 0 breast cancer. Fishel revealed her diagnosis to encourage other women to get regular mammograms so cancer can be detected in its earliest stages.
During her announcement on an episode of the podcast Pod Meets World, Fishel said her treatment plan included surgery to remove the cancer cells and unspecified follow-up treatment. As part of her announcement, she said her cancer was “high-grade DCIS with microinvasion.”
The word “microinvasion” means that Fishel actually should have been classified as a stage 1 cancer, because the cancer had breached the membrane of the milk duct, said breast surgeon Jill Oxley, MD, FACS, who is the medical director of Breast Care Services for Cape Cod Healthcare.
“Stage 0 is non-invasive, meaning it doesn’t have the ability to spread outside of the breast, Dr. Oxley said. “DCIS is what we call a ‘non-obligate precursor’ of invasive breast cancer, so what that means is it can turn into invasive cancer, but it doesn’t always.”
It’s estimated that 20 to 30 percent of DCIS will progress to invasive breast cancer, but it is also estimated that up to 50 percent of DCIS recurrences will be invasive breast cancer, Dr. Oxley said. One of the other issues with DCIS is that it is usually diagnosed with an image-guided needle biopsy. That means that when the tissue is removed, either by a lumpectomy or mastectomy, the diagnosis might actually change to invasive breast cancer. That occurs an estimated 15 to 50 percent of the time, she said.
DCIS is Fairly Common
“We see quite a bit of DCIS,” Dr. Oxley said. “It’s estimated that 60,000 women in the U.S. are diagnosed with DCIS every year and that makes up between 20 and 25 percent of all of the cancers that are picked up on routine screening of mammography.”
Dr. Oxley recommends that her patients undergo the standard treatment for DCIS, which is a lumpectomy with radiation with hormone therapy for those who have estrogen- and or progesterone receptor-positive DCIS, but she acknowledges that that might not be the right treatment for everyone. For example, active surveillance might be a reasonable treatment for an elderly woman with competing medical problems.
There is some debate among doctors and researchers whether all women with DCIS should receive treatment. A study done at Columbia University Vagelos College of Physicians and Surgeons points to the fact that since not all cases of DCIS transform into invasive cancer, doctors may be are overtreating women with unnecessary surgery, radiation and hormone therapy.
The study indicated that radiation and hormone treatments don’t change the 10-year survival rate, which is 98 percent regardless of whether they receive treatment. But the study did note that treatments do reduce the rate of breast cancer down the road.
Dr. Oxley pointed to three other large new studies that are being done to determine whether active surveillance is a good option for patients with DCIS: the COMET study in the U.S., the LORIS study in the U.K. and the LORD study in the Netherlands.
“The trials are being done so that we can find out who we are overtreating, because if only 20 to 30 percent of DCIS will progress to invasive cancer, then clearly we are overtreating a lot of women,” Dr. Oxley said. “But we need to figure out who needs treatment for DCIS and who doesn’t. It will be really exciting to see what the results of these studies show us, but we’re not there yet.”
