Is surgery the suggested treatment option for breast cancer in situ?

Question

Hello doctor,

My mother is 68 years old. She was just diagnosed with breast cancer in situ. The medical team says it is not aggressive. The hospital in which she was treated already did a biopsy on her breast. I read today that biopsies can actually open the door to cancerous cells and allow the spread. Also, her surgery is already scheduled for this week. I also read that surgery at such an early stage may cause more problems than there was original. I read an article online. I do not know how reliable it is? Also, in my place, doctors follow a protocol, they will not offer anything but the conventional way which is surgery, no alternative treatments are suggested. What is your advise?

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your reports. (attachment removed to protect patient identity).

As far as I was able to understand, the lesion is a high grade (microcalcification and necrosis). Though I had to use google translation.

What I am going to tell you is as per recognized and approved evidences it does not include newer theories and understanding which are though upcoming have not yet come in clinical practice.

High-grade DCIS (ductal carcinoma in situ) increases the risk of invasive cancer. What above article has mentioned regarding mortality being the same in DCIS patients and normal individuals is not totally correct. The study which showed mortality of three percent, these patients were treated and it is not sure whether the similar mortality is due to treatment or nature of the disease.

The medical community is clear that some DCIS are low grade and may not need treatment and thus have removed DCIS from premalignant. But high-risk DCIS increases risk of having invasive component which might be missed just by biopsies. There is some evidence that we can avoid RT (radiotherapy) in low risk group, but none of the mainstream studies have avoided surgery.

The use of hormonal therapy is to avoid recurrence. Now the above article mentions that it does not change overall mortality. But this is due to the fact that we usually detect recurrences earlier and treat them before progressing to advanced stage. If we have not then there is a chance that some of them will progress to aggressive disease.

Regarding biopsy there is enough evidence that it does not increase the chance of cancer spreading. These are just hypotheses. Also, it definitely does not affect overall prognosis. Lastly, being from a medical background I do not have an idea regarding natural treatment. Though I would say that all these are just hypotheses and not proven things. As per my idea, she would need a breast conservation therapy plus radiotherapy, and endocrine treatment depending on the final biopsy result.