DCIS on Dr. Oz show
I have no idea what network airs Dr. Mehmet Oz's show, but next week he'll be discussing DCIS. Probably in a pretty surface-y way, but you never know. Here's the description I stumbled across:
On Wednesday, September 8, Dr. Oz facilitates our national conversation on breast cancer and examines the discussion surrounding ductile carcinoma in situ or DCIS. Esteemed breast cancer specialists Dr. Laura Esserman, Director of UCSF Breast Center, and Dr. Ruth Oratz, a breast cancer surgeon and advisor to Susan G. Komen for The Cure, will discuss the difference of opinions, risks and options for women diagnosed with DCIS.
Comments
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Thanks for posting this. I don't normally watch his show, but I'll set it to tape for next week. I think his show is syndicated and airs on different networks in different markets.
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Kitchewitch,
Thanks for the heads up. Dr. Esserman is awesome. I emailed her about a biopsy they wanted me to do right after she was quoted extensiviely in an article about unnecessary biopsies that was published in USA Today. She responded within 24 hours with helpful guidelines that I used in talking to my radiologist.
She is one of the people at the forefront of DCIS research at UCSF. I am always interested in what she has to say.
Sandie
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Sandie, I'm interested in Dr. Esserman too. It seems like every time I come across a doctor who is aggressively questioning DCIS treatment and trying to find ways to see which lesions have stronger potential to mutate to invasive cancer, it's someone in California.
Incidentally, if anyone is interested, I signed up for a google alert on DCIS + breast, and every day I get an email with links to whatever shows up in google that day. Sometimes it's new (like this); other times it's links to posts on blogs or something that has been around for a while.
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kitchen
how do you sign up for that?
-c
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iHEART, go to google.com/alerts and put your search terms into the box at left. I put in DCIS + breast, since DCIS comes up in other searches.
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Idiot producers They can't even spell ductal correctly and Oratz is a medical oncologist, not a surgeon.
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it wasnt on Dr. Oz today did i miss it or is it on another day?
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Ack, I forgot about this and was out running errands while it was on. There's a "repeat" show that's on now but since I don't normally watch Dr. Oz, I don't know whether it's a repeat from earlier today or another day. This show seems to be all about colon cancer so I don't think it's the right show, unless he's going to draw a parallel between polyps and DCIS or something.
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I missed it! It was today.....Is there any way to see it? Perhaps online?
Sandy from Cincinnati
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its not on the website doctoroz.com which is pretty disapointing. Its in the press release but not even mentioned on the site. . . .
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i watched the entire episode of Dr. Oz today here in buffalo, ny and it was all about embarrassing questions, wonder if maybe it aired on a different day here? ill check tomorrow maybe we are a day behind?? this happen to anyone else in upstate ny?
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jpmercy: I saw the same episode here in putnam county, ny yesterday. I decided to tape his shows for the week so I don't miss the episode about DCIS. Today's episode at 3pm looks like it's going to be about insomnia and hormones. I'm wondering if this might be the episode where he talks about DCIS?
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Was the show supposed to air on Wednesday, or be taped on Wednesday? I think that the new season for daytime shows starts next week. I know that the Dr Oz show tapes in advance, so they may have been trying to solicit audience members for the topic.
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I know it's not my fault, but sorry, everybody. I rushed home to watch the first episode, which was mostly about bowel issues. Have no idea what the schedule is - I just copied and pasted the thing above. Nothing on their website mentions DCIS in upcoming episodes - it might be on next week? I don't think much of the producers of this show, so far. As Sweaty pointed out, they couldn't spelll ductal correctly.
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I was just flicking through the tv channels and it looks like today's Dr. Oz show is going to be about breast cancer. In my area it comes on at 3pm and then replays the next day at 11am on the Dr. Oz show. He comes on at 2 different times in my area but the earlier time (11am) is always a repeat of the show the day before.
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I watched the show this morning (10:00 am in my area). He had 2 specialists on that explained DCIS very well and the different treatment options available. I loved his demo on why a surgical biopsy needed to be done after a needle biopsy is done. and discussed a new possible diagnostic procedure that may be used in the US shortly.
Sheila
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I was very disappointed in the way it was explained. One didn't think it should be called cancer, but didn't explain why and the other thought it should be called cancer, but didn't explain why. She ended it up calling DCIS " a marker for cancer." That in my opinion was not a very strong case. No one discussed grade, or margins or necrosis. I suppose that time was an issue, but what followed was a discussion about phlegm.
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This is outragous! One didn't think it should be called cancer?! They need to talk to me! I have the DCIS breast cancer. The only difference is that it has been caught early and is still cancer cells in the ductal works of your breast versus having spread outside the ducts or formed a tumor yet. Because I had these cancer cells throughout my complete breast ductal system, I had to have mascetomy done and am on tamoxifen for 5 years now. Try telling me that it shouldn't be called cancer!
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Not to change the subject. but a Dr from Sloan Kettering was on the View I think yesterday. And he Mentioned DCIS as pre cancer. he also stated that Early BC has a 98% CURE rate.
That made me very mad coming from Sloan Kettering
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When I met with my port surgeon he was curios as to why I had a sentinel node biopsy in the other breast that only had LCIS stating that LCIS is precancer. Not sure if Dr. Oz discussed LCIS on his show.
(reason why was MRI showed 4 suspicous spots but there was only 1 LCIS spot).
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He only talked about DCIS. I would have been interested in LCIS as well because I had a bit of that as well as the ILC .
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The discussion on the Dr. Oz show focused on DCIS because DCIS is a very hot topic within the medical community these days. This is because in the U.S. every year approx. 60,000 women are diagnosed with DCIS. Add to this the controversy over the definition of DCIS - with most experts calling DCIS a pre-invasive or non-invasive cancer, but with some calling DCIS a pre-cancer - and you have a good topic for a mass market t.v. show. LCIS, on the other hand, affects only a few thousand women a year. And while there is much that is unknown about LCIS (and unquestionably much more research needs to be done), it is now generally agreed that LCIS is a pre-cancerous high risk condition. So DCIS affects more women and 'what DCIS is' is more controversial. That's why DCIS was discussed.
As for the definitions:
LCIS:
- Despite the fact that its name includes the term "carcinoma," LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term "lobular neoplasia" instead of "lobular carcinoma." A neoplasia is a collection of abnormal cells. http://www.breastcancer.org/symptoms/types/lcis/
- Although it sounds like cancer, lobular carcinoma in situ (LCIS) is actually an indicator that you have a higher chance of developing breast cancer in the future. LCIS is an area of abnormal tissue growth that occurs within - and stays within - the lobules or milk glands located at the end of the breast ducts. http://www.mayoclinic.com/health/lobular-carcinoma-in-situ/DS00982
DCIS:
- Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasn't spread beyond the milk duct into any normal surrounding breast tissue. http://www.breastcancer.org/symptoms/types/dcis/
- Ductal carcinoma in situ (DCIS) is considered the earliest form of breast cancer. In DCIS, abnormal cells multiply and form a growth within a milk duct of your breast. DCIS is noninvasive, meaning it hasn't spread out of the milk duct to invade other parts of the breast. http://www.mayoclinic.com/health/dcis/DS00983
The reason that LCIS is most often considered to be a 'high risk' factor (and not breast cancer) while DCIS is considered an early stage breast cancer is because of how LCIS and DCIS cells behave. It appears that LCIS cells rarely convert to become invasive cancer; instead, the presence of LCIS indicates a higher (than average) risk that the patient will develop invasive cancer, in either breast, at some point in the future. DCIS acts very differently. It is the DCIS cell itself that undergoes one final biological change to become an invasive cancer cell. So the DCIS cell and the subsequent invasive cancer cell are actually one and the same. This is why most experts consider DCIS to be cancer.
So, back to the Dr. Oz show and the discussion about DCIS. The expert who said that DCIS is not cancer based this on the definition of cancer that says that all cancers have the ability to metastasize (spread) thoughout the body. Since DCIS cells, in their current state, don't have the ability to move outside of the milk ducts, DCIS therefore is not a cancer. That was the explanation. Other than providing this explanation, there was no further discussion on this issue. Having two breast cancer experts on the show, one who considers DCIS to be cancer and one who considers DCIS to be pre-cancer could have lead to some interesting discussion. Unfortunately not.
There was agreement from both doctors that sometimes DCIS is serious and needs immediate treatment (and may in fact be hiding invasive cancer that is already present) but in other cases DCIS may not need to be treated as seriously. The problem was that this discussion morphed into a discussion about calcifications. It was explained that calcifications seen on a mammo are a possible sign of DCIS (although it was never explained that 90% of calcs are in fact harmless and not cancer). It seemed to be suggested that non-serious cases of DCIS could be addressed by a "wait and see" approach when calcs are seen on a mammo. But of course the "wait and see" approach is only used when calcs are highly unlikely to be DCIS - this approach is never suggested when there is a reasonable possiblity that the calcs might be DCIS (or something worse). So the discussion of calcs and DCIS was muddled together in a way that was both misleading and uninformative. And in fact there no real discussion on how low risk DCIS should be treated.
If someone watching this segment had no prior understanding of DCIS, after watching they either would have been totally confused or very misinformed.
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hmmm perhaps my evil boss was watching Dr. Oz about DCIS and thats why he's been acting like there has been nothing wrong with me. . . .
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*sigh*
If it's a "pre cancer" or "a marker for breast cancer", they need to make sure that everyone knows it, including the people treating it. All of my papers said breast cancer, and I was told that what I had was breast cancer. This was over 3 years ago and I'm *still* upset and a bit scared. Had they told me all I had was a marker for cancer I would have felt very different.
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Ah, sjack, what you said is exactly the reason why some say that DCIS should not be called "cancer". Because it's too scary for the women who are diagnosed, when in fact the condition itself is not life-threatening. That's a valid point, IMHO. I do think that there are some women who overreact to a diagnosis of DCIS. They are panicked and as a result, they may overtreat their DCIS, which might not actually be a very severe or aggressive case.
But I worry that if DCIS is not called a "cancer" then we will have to deal with the flip-side of what happens now. If we call DCIS a pre-cancer, we will have women who wrongly assume that DCIS is not a serious condition. They may choose not to treat it or they may feel that they can get with just minimum treatment. We see situations like that on this discussion board quite often, when women are told that DCIS is a pre-cancer. We get posts asking why any treatment is necessary. In cases where the DCIS is small and not aggressive, minimum treatment may be fine, but the fact is that a large percentage of cases of DCIS are very serious and with these cases, under-treatment could lead to severe implications (a diagnosis of invasive cancer, potentially not be found until it is later stage or even mets).
So rather than call DCIS a pre-cancer, I think a better approach is to address the issue of over-reaction with education and proper communication. When my doctor told me about my diagnosis, he was very clear in explaining what DCIS was (that it was the earliest stage of breast cancer, at a point at which it wasn't life-threatening) and he explained the very small additional risk that I face from the microinvasion that was also found. I knew from that phone call that I was lucky that my cancer was found early and that my prognosis was excellent. I am shocked when I read here about how poorly DCIS is explained by so many doctors; women come here not understanding at all what their diagnosis is and what it really means. That's a failure within the medical community, and deciding to take the word "cancer" out of DCIS is not, in my opinion, the appropriate way to deal with this failure. Address the issue, don't use a name change to try to hide it. Force doctors to learn about DCIS. Stress to doctors the importance of properly explaining DCIS and the treatment options.
And if it's decided to change the name of DCIS so that the word "cancer" is removed, don't do that until the medical community has the ability to determine, with a much higher degree of certainty than they can today, which cases of DCIS are in fact low risk and require minimal treatment, and which cases of DCIS are high risk and require the same treatment as other early stage breast cancers. Then divide DCIS up into those two groups, rename the first group and call it a pre-cancer, and leave the rest as DCIS, a Stage 0 pre-invasive cancer.
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I must admit that if my DCIS was called pre-cancer I would NEVER have agreed to the mast and radiation. Never in a zillion years.
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Beesie: Just giving a bump for Beesie's response !
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My DCIS was not discovered until a MRI-assisted biopsy was done. Neither the mammagram nor the ultrasound showed any evidence of disease. Because I would worry myself to death about whether it was cancer or not or if it spread, I had a mastectomy on the affected side and a prophalactic mastectomy on the "normal" breast. Upon pathologoic examination, both breasts had DCIS!
If the medical community cannot agree on what DCIS is - how are we supposed to know?
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mom3band1g, I know exactly how you feel. I had a microinvasion as well as lots of DCIS and I remember that when my surgeon said he was recommending a mastectomy, my first question was whether the mastectomy was necessary because of the microinvasion. He said no - the microinvasion was tiny and could easily be removed with a lumpectomy; it was because of all the DCIS that I needed the mastectomy. It was not easy for me to get my head around that - here I had caught my breast cancer at the earliest stage and yet I still needed to have a mastectomy? That made no sense to me. If instead of calling DCIS "cancer" my doctor had called it a "pre-cancer", I don't know that I could have dealt with it all.
And that's the issue with the possible renaming of DCIS. There are lots of cases like this - women who have larger amounts of very aggressive DCIS, DCIS that is right on the verge of becoming invasive (mine had already started). To suggest that these are pre-cancers is misleading and dangerous. Whenever I read articles about this issue in the press (either medical/scientific press or mass media), the discussion always focuses on those cases of DCIS that are low risk. For women with a low risk diagnosis, perhaps calling their diagnosis a "pre-cancer" is more appropriate, but the problem is that currently all DCIS is lumped together and a renaming would impact everyone diagnosed with DCIS, not just those who have low-risk DCIS.
The medical community needs to look at this issue not just from a single perspective - that some DCIS is low risk and may be over-treated - but also recognizing that DCIS is a heterogeneous disease and some cases resemble 'cancer' much more than they resemble 'pre-cancer' and these cases must be treated just like any other early stage cancer.
Kathleen, I think that the reason that the medical community can't agree is because all DCIS is lumped together. Some diagnoses of DCIS are more like a pre-cancer and other diagnoses of DCIS are more like cancer. That's the problem.
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I haven't been on these boards long but early on recognized Bessie as being one of the greats. I tip my hat to you and am glad to get a chance to do so. Seasoned, well reasoned and thoughtful posting are your trademark. I am so glad to see you weighing in on LCIS.
The fact that little research has been done on what's generally considered the precancers and the errors that occur in pathology directly led me to a surgical suite to have a PBMX following one diagnoses of LCIS.
What especially complicates the diagnosis of LCIS or DCIS or ALH or ADH is the fact that they may have contributing factors that could lead to an invasive cancer. Or not. We have unknown protective influences. No one knows all those factors yet.
In addition, additional information considering our breast needs to be considered when deciding just how cooly we approach pre or noninvasive cancers. LCIS and DCIS and for that matter ALH and ADH can never be correctly assessed without knowing additional findings concerning conditions of the breast.
Lots of us have been around enough to see decisions of how to think of breast cancer change over time. It will change again. Things evolve. Lots of us have been in the cross hairs of dueling diagnoses. For me PBMX was by far to be the most reasonable course of action and by no means overtreatment.
I wish for all of us personalized and up-to-date care with access to all the available tools out there as we wrestle with decisions of how to proceed.
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