New research looks into whether low-risk, non-invasive breast cancers may be overtreated

New research is looking at whether some low-risk, non-invasive breast cancers may be overtreated and could instead be closely monitored.

Dr. Sheldon Feldman, chief of breast surgical oncology at Montefiore Einstein Comprehensive Cancer Center, is leading an active surveillance study where patients are being monitored and taking low-dose hormone therapy.

Feldman is using this to treat ductal carcinoma in situ (DCIS), which is a very early, non-invasive form of breast cancer. It is often called stage 0 breast cancer. 

"The need to treat ductal carcinoma in situ is only to prevent it from possibly turning into invasive cancer," he said.

DCIS makes up about 35% of the 300,000 new breast cancer cases in the United States, which is about 75,000 patients.

"The only group that would go on to surgery would be those patients who are identified as having disease progression on the follow-up MRI or mammogram," Feldman said. "So, actually, a very small group of the patients who initially are diagnosed with ductal carcinoma in situ need to go on to surgery."

Julia Stalder, 46, is a Montefiore Einstein patient who was diagnosed with this type of cancer two and a half years ago.

"I was just having a routine mammogram, and they spotted calcifications on my mammogram and then that led to a biopsy," she said.

Other opinions recommended surgery for the cancer, but doctors at Montefiore told her she was a candidate for active surveillance.

"It gave me more anxiety to rush into getting a mastectomy than following active monitoring," Stalder said. 

Now, she comes into the center every six months to have a mammogram or other imaging. Her latest one confirmed everything has remained stable.

"I know that I'm being monitored so closely that if anything were to progress, it would be caught so early that it would be treated right away," she said. "I feel really grateful that I actually have this as an option."  

Stalder also started a nonprofit called DCIS Understood to provide resources to other women going through a DCIS diagnosis.