One of the best things about my job is
that I see patients who have a potentially lethal diagnosis
and I'm able to be part of what allows them to be cured of their disease. The flip side
is that one of the least rewarding experiences
I have is when I see a patient who is so fearful
and so not at peace with her own body that she feels that she has to do extraordinary
things to be free of her anxiety of breast cancer. [MUSIC]
My daughter's initial reaction was, Mom,
if it was me I'd take it out. You just get rid of it.
My husband and I did a ton of research, and we reviewed studies, and all the information
out there, and decided that really we don't have to have
surgery. That it's not life-threatening, and I'll probably
die from something else.
[MUSIC]
I'm fortunate to be
on the early side of things where most of the patients
I see have very early, very treatable problems and
I think that's how I got interested in DCIS, because of all
the so-called cancers that we diagnose now, DCIS
is the very earliest form.
[MUSIC]
Active surveillance is very new. And for many people, both on the physician's side
and the patient's side, it's a scary proposition. I'm certainly
not condoning it for everyone. I'm not recommending that everyone
with DCIS follow a path of active surveillance. But I think
it should be considered in the context of all the options
that patients have. All of us have different comfort
levels of how far we're willing to go to be sure we
don't die of this and that other disease. But we
all die of something. And we can't prevent everything. [MUSIC]
[MUSIC]
So in April of 2014 I was diagnosed with DCIS. When they gave me the diagnosis I initially
felt a lot of dread, got sick to my stomach and just
thought oh no so what is this going to lead to. My daughter's initial reaction was, mom,
if it was me, I'd take it out. And that was initially
how she felt until we discussed it. And when we
talked about the risks of surgery and radiation treatments,
and some of the things that can happen with that, and
the fact that these are pre-cancerous cells that
may just sit there and never do anything. She came around.
So, DCIS stands for ductal carcinoma in situ. And the
in situ part is that the cells, the abnormal cells
are contained within the ducts of the breast Once the cells
break out of the ducts its called an invasive cancer,
and those are the cancers that can spread to the
lymph nodes and can spread to other parts of the
body and eventually cause mortality.
There have been a couple of very important studies that have been published
lately which have shown that for the very low risk DCIS
Whether you ever operate on them, whether you do a
lumpectomy or whether you do a mastectomy, the patients
are equally likely to not die of breast cancer. So removing
both your breasts at that phase really doesn't
help a woman to live longer. And I feel that for some of
those patients they see mastectomy as being a way to
rid themselves of anxiety. And that makes me sad.
I think there are much better ways to reduce anxiety than
to do a pretty major operation after which you're never
really going to be the same. And the side effects
that patients have in terms of discomfort with themselves. Never
feeling like they're whole again. A lot of the work
that I do in clinic is being with patients at
probably one of the most vulnerable and scary times of
their lives. And to be part of that process and
to see patients through that is incredibly rewarding.
The inital fear that you have I think is just because you
don't know what's going to happen, but you know if
you read the studies and you look at the information out there, I don't feel afraid at all. I feel
great about my decision. If options were given to women,
more women would choose active surveillance, but because there's no
options out there, people don't know to even ask.