Let’s face it: no cancer is a good cancer. But if you do get cancer, being diagnosed at Stage 0 might be considered a best-case scenario.
More women are diagnosed with breast cancer than with any other cancer in this country. This year, an estimated 252,710 women in the United States will be diagnosed with invasive breast cancer, with 63,410 of those women being diagnosed with "in situ" breast cancer, often referred to as Stage 0. According to the American Cancer Society, the 5-year relative survival rate for women with stage 0 breast cancer is close to 100%.
In this important segment, Helen Cappuccino, MD, FACS, Assistant Professor of Oncology in the Breast Surgery Division, Department of Surgical Oncology at Roswell Park Comprehensive Cancer Center, discusses stage 0 breast cancer and the incredible advances that have made this a very treatable cancer.
Selected Podcast
Stage 0 Breast Cancer
Featured Speaker:
Learn more about Helen Cappuccino, MD
Helen Cappuccino, MD
Helen Cappuccino, MD, is delighted to be on staff at Roswell Park Comprehensive Cancer Center. After a decade in private general surgical practice where she treated many women with breast cancer, she accepted an invitation to join Roswell exclusively in 1999.Learn more about Helen Cappuccino, MD
Transcription:
Stage 0 Breast Cancer
Bill Klaproth (Host): Let’s face it. No cancer is a good cancer, but if you do get cancer, being diagnosed at Stage 0 might be considered a best-case scenario. Here to talk with us about Stage 0 breast cancer is Dr. Helen Cappuccino, Assistant Professor of Surgery at Roswell Park Comprehensive Cancer Center. Dr. Cappuccino, thank you so much for your time today. So, let’s start at the beginning. What is Stage 0 breast cancer?
Dr. Helen Cappuccino, MD, FACS (Guest): Well, when we talk about breast cancer, most people are accustomed to talking about Stages 1 through 4. Stage 0 is a type of breast cancer that’s pretty much the step right before that. It’s breast cancer cells for sure, but the cells together as a whole have not yet developed the ability to do the things that make breast cancer dangerous; that is to grow into surrounding structures or just spread to the lymph nodes or to other areas of the body. So, it certainly doesn’t have the same potential dire consequences that invasive breast cancer does.
Bill: So, this is the earliest, earliest stage you can get it. So, then I would imagine the survival rate for women diagnosed with Stage 0 breast cancer is pretty good.
Dr. Cappuccino: It’s spectacular. Almost normal, actually. They have a higher incidence of breast cancer overall down the road. So, they have to been screened more carefully going forward, but with proper treatment, they can generally expect to live normal lives.
Bill: So, Dr. Cappuccino, can you talk to us, then, about DCIS? What that stands for and what that means?
Dr. Cappuccino: Yeah. Sure. DCIS is shorthand for ductal carcinoma in situ, which is simply just another series of words we use to describe Stage 0 breast cancer. It’s also characterized by the fact that the cancer cells stay within the ducts of the breast, and they don’t grow into the supportive tissues around it. So, it’s simply just another way of describing Stage 0 breast cancer—starts in the ducts and stays there.
Bill: So, in DCIS, are there symptoms? I mean, women won’t feel a lump in this case, right? It is—
Dr. Cappuccino: Correct.
Bill: —detected through mammography?
Dr. Cappuccino: Yes, indeed. The vast majority of cases of DCIS are discovered by changes in mammography, which is why it’s so important that women go for their regular mammography. Frequently, what you’ll note is calcifications, and not just any calcifications, but there’s a typical appearance. We call them microcalcifications. It’s just like little bits of sand sprinkled throughout the breast that you can see and that seems to be associated with DCIS. So, when that new finding is found on a mammogram, what will usually be recommended is that the patient undergo a needle biopsy, a core needle biopsy, which is done under mammography and then that can be sent off for analysis and tell us whether it’s simply just some normal changes or whether in fact it is a Stage 0 or DCIS breast cancer.
Bill: And who is most at risk for DCIS?
Dr. Cappuccino: It can really happen to any woman. It’s a common misunderstanding that women who have a strong family history of breast cancer are the ones that are most likely to present with breast cancer, but the fact of the matter is for all breast cancers both Stage 0 or DCIS, as well as what we think of as, you know, the usual breast cancer and basic breast cancer Stages 1 through 4, most women who present are the first ones in their family to do so with it.
Bill: And is treatment needed, then, for Stage 0 breast cancer?
Dr. Cappuccino: Yeah. That’s actually a great question and an area of emerging research. For the time being, in the present, yes. All women do require treatment for it. The feeling is that probably some of these cases may not need to be treated. There have been studies done on women who have chosen not to have any treatment for this, and within that group of women, some of them will actually do fine without any progression over years, but unfortunately, many other women do go on to progress and at this stage of the game, we have no way of predicting who will progress, and who won’t. The other reason that we need to remove the area of DCIS in all of these patients is that sometimes in the background, there is some invasive cancer hiding. The needle biopsy is simply just sampling the area. So, we need to remove the whole area to be sure that there’s no invasive cancer in the background.
Bill: So, you talked about a needle biopsy just a minute ago. Are there other tools, then, needed to for complete diagnosis?
Dr. Cappuccino: In terms of diagnosis, really, it’s the core biopsy that is going to be the initial step or the foundation of working up the breast cancer. In terms of treatment, we generally completely remove the area of the DCIS. So, we want to get clear margins and normal cells that are completely around the specimen when it’s removed, and then, in most cases, radiation is required afterwards. When we do the biopsy, something that we also check for is whether or not the DCIS is responsive to stimulation by female hormones estrogen and progesterone, and if so, then they can also be placed on a medication that helps to prevent recurrences of the DCIS or future breast cancers on either side.
Bill: So, this is a slow-growing cancer then like?
Dr. Cappuccino: As a rule, yeah.
Bill: As a rule. So, like men with prostate cancer sometimes that active observation is required or some patients decide to do that. Is that kind of the same thing with this?
Dr. Cappuccino: We’re not quite at that stage yet. It’s still the standard of care is to remove and treat all cases. I think the new frontier will be developing testing that can predict who might be able to be observed. Now, in certain select cases, if it appears to be particularly minimal or the patient is extremely frail and is not a candidate for surgery, if they are responsive to those hormones, we can actually put them on those anti-hormone pills and that would help to keep it in check until the patient is healthier and able to withstand surgery.
Bill: So, when you talk about surgery, is this more of an outpatient surgery, then?
Dr. Cappuccino: Absolutely. Usually, this can be taken care of with simply a lumpectomy, followed by radiation treatments. In very unusual circumstances, if it’s quite extensive and involves the entire breast or the majority of the breast, a mastectomy would be required, but in general, far too many women are undergoing mastectomies for treatment of this. Usually, a lumpectomy, followed by radiation is more than enough treatment for this.
Bill: And Dr. Cappuccino, what about ongoing treatment to reduce the risk of re-occurrence?
Dr. Cappuccino: So, yes, that’s something we can definitely do. There are two families of medications that we can offer patients. There’s tamoxifen, which is the drug that’s been around for decades and has a long-standing history of efficacy and relative safety. That’s taken once a day for five years, and then there’s another series of medications called the aromatase inhibitors, which are drugs that block the final formation of estrogen and progesterone and also are extremely effective at preventing future DCIS or breast cancer. Each of them are used in particular circumstances and have different side effect profiles, so we try and tailor that to each individual patient.
Bill: And Dr. Cappuccino, does this, as you talk about this, I’m just wondering, does this run in families? Is this a hereditary thing?
Dr. Cappuccino: Not as a rule, no. No. It’s more common if you have a relative that’s had any breast cancer, breast cancer is more common, but it’s not the kind of thing that we see running in families. It’s the same way if, for instance, the BRCA mutation predisposes to breast cancer within a family.
Bill: Right. And if you could wrap it up for us, what else do we need to know about Stage 0 breast cancer?
Dr. Cappuccino: Well, it’s interesting. When I see women with DCIS for the first time, I say, really, the goal of my visit with you today is to reassure you that this is not what you hear about all the time in terms of invasive breast cancer. The prognosis for this is excellent. You’re going to require some treatment. Yes, it’s scary to hear the words “carcinoma” and “breast” in the same sentence, but this is not what you hear all the time. With proper treatment, you should do extremely well, and go on to live a normal life, and then we talk about the treatments, and usually, they feel a lot better knowing that they’re likely to do very well.
Bill: Absolutely. Well, Dr. Cappuccino, thank you so much for your time today. We appreciate it. For more information, you can visit roswellpark.org. That's roswellpark.org. You're listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I'm Bill Klaproth. Thanks for listening.
Stage 0 Breast Cancer
Bill Klaproth (Host): Let’s face it. No cancer is a good cancer, but if you do get cancer, being diagnosed at Stage 0 might be considered a best-case scenario. Here to talk with us about Stage 0 breast cancer is Dr. Helen Cappuccino, Assistant Professor of Surgery at Roswell Park Comprehensive Cancer Center. Dr. Cappuccino, thank you so much for your time today. So, let’s start at the beginning. What is Stage 0 breast cancer?
Dr. Helen Cappuccino, MD, FACS (Guest): Well, when we talk about breast cancer, most people are accustomed to talking about Stages 1 through 4. Stage 0 is a type of breast cancer that’s pretty much the step right before that. It’s breast cancer cells for sure, but the cells together as a whole have not yet developed the ability to do the things that make breast cancer dangerous; that is to grow into surrounding structures or just spread to the lymph nodes or to other areas of the body. So, it certainly doesn’t have the same potential dire consequences that invasive breast cancer does.
Bill: So, this is the earliest, earliest stage you can get it. So, then I would imagine the survival rate for women diagnosed with Stage 0 breast cancer is pretty good.
Dr. Cappuccino: It’s spectacular. Almost normal, actually. They have a higher incidence of breast cancer overall down the road. So, they have to been screened more carefully going forward, but with proper treatment, they can generally expect to live normal lives.
Bill: So, Dr. Cappuccino, can you talk to us, then, about DCIS? What that stands for and what that means?
Dr. Cappuccino: Yeah. Sure. DCIS is shorthand for ductal carcinoma in situ, which is simply just another series of words we use to describe Stage 0 breast cancer. It’s also characterized by the fact that the cancer cells stay within the ducts of the breast, and they don’t grow into the supportive tissues around it. So, it’s simply just another way of describing Stage 0 breast cancer—starts in the ducts and stays there.
Bill: So, in DCIS, are there symptoms? I mean, women won’t feel a lump in this case, right? It is—
Dr. Cappuccino: Correct.
Bill: —detected through mammography?
Dr. Cappuccino: Yes, indeed. The vast majority of cases of DCIS are discovered by changes in mammography, which is why it’s so important that women go for their regular mammography. Frequently, what you’ll note is calcifications, and not just any calcifications, but there’s a typical appearance. We call them microcalcifications. It’s just like little bits of sand sprinkled throughout the breast that you can see and that seems to be associated with DCIS. So, when that new finding is found on a mammogram, what will usually be recommended is that the patient undergo a needle biopsy, a core needle biopsy, which is done under mammography and then that can be sent off for analysis and tell us whether it’s simply just some normal changes or whether in fact it is a Stage 0 or DCIS breast cancer.
Bill: And who is most at risk for DCIS?
Dr. Cappuccino: It can really happen to any woman. It’s a common misunderstanding that women who have a strong family history of breast cancer are the ones that are most likely to present with breast cancer, but the fact of the matter is for all breast cancers both Stage 0 or DCIS, as well as what we think of as, you know, the usual breast cancer and basic breast cancer Stages 1 through 4, most women who present are the first ones in their family to do so with it.
Bill: And is treatment needed, then, for Stage 0 breast cancer?
Dr. Cappuccino: Yeah. That’s actually a great question and an area of emerging research. For the time being, in the present, yes. All women do require treatment for it. The feeling is that probably some of these cases may not need to be treated. There have been studies done on women who have chosen not to have any treatment for this, and within that group of women, some of them will actually do fine without any progression over years, but unfortunately, many other women do go on to progress and at this stage of the game, we have no way of predicting who will progress, and who won’t. The other reason that we need to remove the area of DCIS in all of these patients is that sometimes in the background, there is some invasive cancer hiding. The needle biopsy is simply just sampling the area. So, we need to remove the whole area to be sure that there’s no invasive cancer in the background.
Bill: So, you talked about a needle biopsy just a minute ago. Are there other tools, then, needed to for complete diagnosis?
Dr. Cappuccino: In terms of diagnosis, really, it’s the core biopsy that is going to be the initial step or the foundation of working up the breast cancer. In terms of treatment, we generally completely remove the area of the DCIS. So, we want to get clear margins and normal cells that are completely around the specimen when it’s removed, and then, in most cases, radiation is required afterwards. When we do the biopsy, something that we also check for is whether or not the DCIS is responsive to stimulation by female hormones estrogen and progesterone, and if so, then they can also be placed on a medication that helps to prevent recurrences of the DCIS or future breast cancers on either side.
Bill: So, this is a slow-growing cancer then like?
Dr. Cappuccino: As a rule, yeah.
Bill: As a rule. So, like men with prostate cancer sometimes that active observation is required or some patients decide to do that. Is that kind of the same thing with this?
Dr. Cappuccino: We’re not quite at that stage yet. It’s still the standard of care is to remove and treat all cases. I think the new frontier will be developing testing that can predict who might be able to be observed. Now, in certain select cases, if it appears to be particularly minimal or the patient is extremely frail and is not a candidate for surgery, if they are responsive to those hormones, we can actually put them on those anti-hormone pills and that would help to keep it in check until the patient is healthier and able to withstand surgery.
Bill: So, when you talk about surgery, is this more of an outpatient surgery, then?
Dr. Cappuccino: Absolutely. Usually, this can be taken care of with simply a lumpectomy, followed by radiation treatments. In very unusual circumstances, if it’s quite extensive and involves the entire breast or the majority of the breast, a mastectomy would be required, but in general, far too many women are undergoing mastectomies for treatment of this. Usually, a lumpectomy, followed by radiation is more than enough treatment for this.
Bill: And Dr. Cappuccino, what about ongoing treatment to reduce the risk of re-occurrence?
Dr. Cappuccino: So, yes, that’s something we can definitely do. There are two families of medications that we can offer patients. There’s tamoxifen, which is the drug that’s been around for decades and has a long-standing history of efficacy and relative safety. That’s taken once a day for five years, and then there’s another series of medications called the aromatase inhibitors, which are drugs that block the final formation of estrogen and progesterone and also are extremely effective at preventing future DCIS or breast cancer. Each of them are used in particular circumstances and have different side effect profiles, so we try and tailor that to each individual patient.
Bill: And Dr. Cappuccino, does this, as you talk about this, I’m just wondering, does this run in families? Is this a hereditary thing?
Dr. Cappuccino: Not as a rule, no. No. It’s more common if you have a relative that’s had any breast cancer, breast cancer is more common, but it’s not the kind of thing that we see running in families. It’s the same way if, for instance, the BRCA mutation predisposes to breast cancer within a family.
Bill: Right. And if you could wrap it up for us, what else do we need to know about Stage 0 breast cancer?
Dr. Cappuccino: Well, it’s interesting. When I see women with DCIS for the first time, I say, really, the goal of my visit with you today is to reassure you that this is not what you hear about all the time in terms of invasive breast cancer. The prognosis for this is excellent. You’re going to require some treatment. Yes, it’s scary to hear the words “carcinoma” and “breast” in the same sentence, but this is not what you hear all the time. With proper treatment, you should do extremely well, and go on to live a normal life, and then we talk about the treatments, and usually, they feel a lot better knowing that they’re likely to do very well.
Bill: Absolutely. Well, Dr. Cappuccino, thank you so much for your time today. We appreciate it. For more information, you can visit roswellpark.org. That's roswellpark.org. You're listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I'm Bill Klaproth. Thanks for listening.