As Prescribed: Breast cancer treatments offer more options than surgery


SAN FRANCISCO (KCBS RADIO) – Right now, the standard treatment for patients with DCIS (Ductal Carcinoma In Situ) – a condition that can develop into breast cancer – is surgery. UCSF breast surgeon Dr. Laura Esserman thinks that could change.

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She’s the primary investigator for a new clinical study for women who have DCIS. Instead of surgery, they’ll be offered endocrine therapy and surveillance.

“Based on a study that we have been doing at UCSF for over a decade, we discovered that, in fact, many women don’t really have a focal risk.
They don’t necessarily have a risk where surgery is going to necessarily be the right treatment,” Esserman, director, Carol Franc Buck Breast Care Center, told KCBS Radio’s Alice Wertz on the latest “As Prescribed” episode.

While DCIS appears very similar to invasive breast cancer, it acts differently, according to UCSF. These small collections of cells lining the milk ducts of breasts don’t have the ability to spread and grow to other parts of the body like cancer. Most importantly, they’re not life-threatening.

“In the past, anybody who came in with ductal carcinoma in situ would get surgery,” Esserman said. “And often radiation. And that surgery could either be taking part of the breast off or all of the breast or both breasts off.”

However, Patients with DCIS do have a higher risk than average of developing breast cancer.

“As it stands, there is no proven way to predict which women diagnosed with DCIS will eventually develop invasive breast cancer,” said UCSF.
“But because of the elevated risk, surgery to remove DCIS – generally a lumpectomy with radiation, or mastectomy – has become standard treatment.
Treatment options are the same as for early-stage invasive breast cancer.”

That’s where Esserman’s research comes in. She wants to help reduce overtreatment for DCIS patients.

“We’re rethinking DCIS as this window of opportunity for prevention, and we’re reevaluating the conditions for active surveillance that might be suitable for treatment,” she said. “So, what does that mean? It doesn’t mean that we just watch you and you go off and don't have any intervention. It means that we're carefully assessing to see what is the nature of this DCIS, what’s behind it?”

A trial for the new treatment will include 400 patients monitored over two to three years at UCSF and other institutions, including University of Chicago, Wake Forest and Vanderbilt. For patients with a hormone-negative version of the condition, there is another study. This focuses on stimulating immune cells.

“In a study I just presented, half of them went away, said Esserman. She said both lines of research are “super exciting” developments for DCIS treatment.

Listen to this week’s “As Prescribed” to learn more. You can also listen to last week’s “As Prescribed” about a unique device helping children with gut pain here.

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