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Carla S. Fisher, MD, is an assistant professor of surgery at the Perelman School of Medicine and a breast surgeon. Dr. Fisher sees patients at the Rena Rowan Breast Center. In this blog post, Dr. Fisher discusses ductal carcinoma in situ, or DCIS, and why sometimes when it comes to treatment for breast cancer, less is more.


In 2011, I wrote an article for this blog about the evolution of the surgical treatment of breast cancer. I discussed the progression of breast cancer surgery from a deforming procedure to breast preservation with better outcomes. As I considered what to write about in 2013, I was immediately drawn to a story I recently listened to on National Public Radio (NPR).

The story was entitled “When Treating Abnormal Breast Cells, Sometimes Less Is More” and it discussed two women’s very different decisions for the treatment of their ductal carcinoma in situ, or DCIS.

DCIS is a very early form of breast cancer. On a staging scale of 1 to 4, DCIS represents stage 0.

Each year approximately 70,000 women are diagnosed with DCIS and it accounts for approximately 1/3 of all breast cancers that are diagnosed.

Like invasive breast cancer, the surgical options for patients with DCIS include lumpectomy and mastectomy. Treatment for DCIS can also include radiation and a medication called tamoxifen.

In the story that I mentioned, one woman chose to undergo bilateral mastectomy (removal of both breasts) as treatment for her DCIS and the other patient elected to forego surgery altogether and was being treated with tamoxifen only. Treating DCIS with tamoxifen only is currently not the standard of care but has been suggested as a possibility for certain types of this early stage of breast cancer.

I mention this story on NPR because it reminded me of our continuing evolution in the surgical treatment of breast cancer. Treating any form of breast cancer with medication only would have been unheard of even 50 years ago!

How do these changes in surgical (or non-surgical) management occur? These changes do not (and should not) happen quickly. They require large groups of patients followed for many years on clinical trials. While new treatment options are exciting, they require close observation and follow up to make sure they are safe and effective.

At the Abramson Cancer Center, we have over 20 clinical trials for women with breast cancer. Our clinical trials include everything from intraoperative imaging of breast cancer to surgical vaccines to radiation using proton therapy. Patient participation in clinical trials is always voluntary but it is what has allowed us to transition from “radical mastectomy” to “breast conservation” surgery.

When it comes to breast cancer treatment, we have shown that “sometimes less is more." As we look to the future, we know that the advances in the treatment of this cancer will only continue to improve. I look forward to that.