What is “Stage 0” Breast Cancer and How is it Treated?

What is stage 0 cancer?

Stage 0 cancer is when cells in the body look like cancer cells under a microscope but have not left their original location. They have not invaded surrounding tissues and are therefore also called carcinoma in situ or carcinoma in situ. They may not be called cancer at all.

“Many people think of this as a kind of precancerous lesion,” says Julie Nangia, an oncologist at Baylor College of Medicine in Houston.

There are many different types of stage 0 cancer, depending on which tissue or organ the cells came from. Some cancers, such as sarcoma (cancer of the bone or skin), do not have a stage 0.

Fishel’s diagnosis is called ductal carcinoma in situ (DCIS), which means that some cells within the milk ducts of her breast look abnormal, but those cells have grown outside the ducts and haven’t migrated into the rest of her breast tissue.

The problem is, it can happen: If abnormal cells break through a milk duct, the severity of the cancer that follows can range from Stage 1 to the most advanced Stage 4, depending on the size of the tumor and how far the cancer has spread throughout the body.

How common is DCIS?

Before regular mammography screening became the standard, DCIS accounted for just 5 percent of breast cancer diagnoses, says Sarah Javid, a breast cancer surgeon at the Fred Hutch Cancer Center in Seattle. (SN: June 13, 2014).

DCIS currently accounts for approximately 20 percent of newly diagnosed breast cancers, with approximately 50,000 cases diagnosed each year in the United States and 1 in 1,300 cases detected by mammogram.

Still, stage 0 breast cancer rarely has any symptoms, so you may not know you have it. “Many women have DCIS and don’t know it, especially older women, because it’s typically an age-related disease,” Nangia says.

For other stage 0 cancers, the situation is different. Stage 0 cancers of other internal organs: Too small to show in scanWidespread screening tests in other organs may not be safe and may be too resource intensive to implement for the entire population.

The main exception is stage 0 skin cancer, which may be visible on the skin. This diagnosis is even more common than DCIS, with approximately 100,000 cases expected in the United States by 2024.

How do you know if you have DCIS?

Most cases of DCIS are found during routine mammograms, which people with breasts are recommended to have annually starting at age 40 or 45. That’s how Fishel was diagnosed with DCIS.

“That’s exactly why we want women to get screened with mammograms,” Nangia says. “We want to catch cancer at its earliest stages, when it’s very easily treatable.”

How is DCIS treated?

Most DCIS is treated with surgery, radiation therapy, or a combination of both. Chemotherapy is never recommended.

The surgery is a localized procedure called a “lumpectomy,” which removes only the areas that look like cancer. If there are multiple DCIS in the same breast, a total mastectomy may make sense. Some patients then undergo radiation therapy to further eradicate the cancer cells, while others undergo hormone therapy to lower the chance of recurrence.

“The goal of treatment is really twofold,” Javid says. First, treatment can prevent DCIS from progressing to invasive cancer. Treatment can also rule out other invasive cancers that might be hiding near the DCIS but missed by biopsy. When pathologists examine tissue removed during surgery, there’s a 5 to 20 percent chance they’ll find invasive cancer already there, Javid says.

Survival rates are good. Stage 0 breast cancer patients have a normal life expectancy of: The survival rate is about 98 percent. After 10 years of follow-up.

Is surgery always the best treatment?

That’s up for debate: It’s not clear whether the longer life expectancy is because screening catches abnormal cells before they become invasive, or because those abnormal cells never get to invade other tissues.

“What we know now is that not all DCIS cases will progress to invasive cancer, and even if they do, they may not progress to invasive cancer in a patient’s lifetime,” said Shelley Huang, a surgical oncologist at Duke University School of Medicine in Durham, North Carolina. video Explain her research.

“As screening technologies improve, we’re able to detect earlier disease that looks like cancer but doesn’t necessarily behave like cancer,” Fan says. “This means that for the majority of women who are diagnosed with DCIS and treated, these treatments may not actually provide much benefit to the patient.”

Are there any other options?

The main alternative to surgery is called active surveillance or watchful waiting, which basically involves monitoring the cells and waiting to see if something terrible happens.

This may be a familiar thought to anyone diagnosed with slow-growing prostate cancer. In the past, a diagnosis of prostate cancer always led to the recommendation of surgery and radiation therapy. But clinical trials have shown that men who monitored their cancer and postponed surgery until it became aggressive did better. Life expectancy was similar For those who remove cancer cells.

In the case of DCIS, Ongoing clinical trials Trials have been conducted in the UK, Europe, the US and Japan to see whether active surveillance produces better or worse outcomes than surgery. At least one of them, COMET Research The study is expected to publish its results by the end of 2024, said Thomas Lynch, a social scientist at Duke University Medical Center in the US.

“If these results show that active monitoring is a safe and effective alternative to surgery, it may increase treatment options for women diagnosed with low-risk DCIS,” he says.

But because there’s no way to tell which DCIS cases will become risky, doctors generally recommend treating all cases as if they will become risky.

“I don’t think we should underestimate the psychological impact of being left untreated with breast cancer,” Nangia said. “It causes a lot of anxiety for patients. … There is definitely a psychological component to all of this.”

Is there a way to know which of these abnormal cells will become invasive cancer?

Unfortunately, no. At least not yet.

Doctors have a grading system to classify which cells they think are at highest risk of becoming invasive: low grade is the least likely, and high grade is the most likely. Fischel has been diagnosed with high-grade DCIS that has begun to spread into nearby tissue, suggesting surgery would be a good fit.

However, many Research groups around the world are working toThey are looking for features of stage 0 cells or their environment that could neatly distinguish preinvasive from dormant cases. (SN: September 27, 2013).

In a 2022 study, Calcium Phosphate Minerals The goal is to eventually link details about the tumors that form within the lumen of DCIS to the progression of the disease. Some studies are looking at the genome of cancer cells to find warning signs. Others are looking at the molecular properties of the cells themselves, or their microenvironment in the body.

Would an announcement from a celebrity like Danielle Fishel help?

“Of course it helps a lot,” Nangia said, “especially when it’s done in a thoughtful way like John does.”

Nangia also pointed to the example of Angelina Jolie, who went public about her family’s cancer history in 2015 and decided to undergo preventive surgery, sparking a national debate about how genetics affect cancer risk. (SN: April 10, 2015).

Celebrity declarations can not only raise awareness, but also encourage previously hesitant people to get tested.

“I think now women who haven’t had a mammogram will say, ‘I should, too,'” Nangia said. “We hope to see more people coming in for preventive care.”