Mammograms revolutionised breast cancer diagnosis (Image: ER Productions/Corbis)
THE lump in her right breast was smaller than a pea. When she first noticed it, last August, 28-year-old photographer Ellen Doherty was busy working on an exhibition. She put off visiting the doctor for a month.
When Doherty finally went, the doctor said it was probably nothing to worry about. But they did a scan to be sure – and that led to several more tests. Finally they said she had a 2.8-millimetre tumour known as ductal carcinoma in situ, or DCIS.
Like many women given this diagnosis, Doherty had never heard of it before. She quickly devoured any information she could find, but came away confused.
The term “in situ” means that the cancerous cells are contained within the breast’s milk ducts and have not invaded the surrounding tissue. This kind of lesion is not harmful unless it progresses past that stage and becomes invasive, but it is treated just as aggressively as invasive cancer. Yet this approach is increasingly being questioned as evidence emerges that for some women DCIS would not turn out to be dangerous.
In fact, DCIS could be regarded as a creation of modern medicine, as most cases are found through breast screening – 30 years ago it was rarely diagnosed. The fear is that screening may be leading us to cut out lumps that, left alone, would have never caused a problem. “Are we helping people by diagnosing it, or are we making things worse?” asks Beth Virnig, who monitors cancer surveillance and detection data at the University of Minnesota in Minneapolis. …
