Understanding Stage Zero Breast Cancer
- Danielle Fishel says her stage 0 breast cancer was discovered through a routine mammogram despite having no symptoms. Now she’s urging others not to delay screenings since early detection can be life-saving.
- Stage 0 breast cancer refers to DCIS otherwise known as ductal carcinoma in situ. DCIS are abnormal cells that line the duct in a breast. A normal breast comprises lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
- The U.S. Preventive Services Task Force (USPSTF) now recommends that women have mammograms every other year beginning at age 40.
- If you have a higher risk for breast cancer due to a family history or a genetic mutation, talk to your doctor about whether screening should start earlier or be done more frequently.
Fishel, now host of the new American Idol Official Podcast, explained having no symptoms whatsoever during a recent interview with the magazine First for Women.
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Fishel advises anyone hearing her story not to wait for symptoms to arise, warning that doing so could mean the cancer might be detected at a much more advanced stage.
Further sharing her story with First for Women, Fishel said, “I had a mammogram the year before that was clean, and when I got the reminder to book my next one, I did it right away. It would have been so easy to push it off because we’re all so busy, and it was summer and we had all these activities planned. It was the least fun thing to do, but I just went and got it done.”
She then noted how her life-saving mammogram found approximately one millimeter of cancer, something she knows she “wouldn’t have felt.”
Fishel added, “I wouldn’t have had symptoms. I’m so grateful I caught it when I did, because even with stage zero, there is no easy cancer.
“I still had two lumpectomies, 20 days of radiation, and I have to take medication every day for the next five years.”
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The beloved podcaster, who also hosts the iHeartMedia podcast, “Teen Beat with Danielle Fishel,” continued, “The longer you put off screenings, the less you know what could be going on. The earlier you find something, the better your outcomes are, especially with how much cancer treatment has advanced.”
Fishel then admitted she knows others choose to delay cancer screenings due to fear, but she insists, “avoiding it doesn’t change anything.”
She concluded, “You just have to go and get it done.”
Danielle Fishel’s Breast Cancer Journey
Speaking on an earlier episode of the Pod Meets World podcast, which Fishel co-hosts with her “Boy Meets World” co-stars Rider Strong and Will Friedle, she revealed, “I was diagnosed with high-grade DCIS (ductal carcinoma in situ) with micro-invasion.”
Fishel said she underwent surgery to remove the cancer and received follow-up treatment.
In the aftermath of her diagnosis, Fishel felt increasingly empowered to share her cancer journey, explaining further, “What I realized is the more people I talk to, the more people have had their own experiences, either themselves being diagnosed with cancer or a family member who’s been diagnosed with cancer.”
She expressed deep gratitude that her annual mammogram allowed her to detect the cancer before it had a chance to develop further.
In hopes that her story will inspire others, she added, “If it’s time for your appointment, if you’ve never had an appointment before, get in there. If you have to find out that you have cancer, find out when it’s at stage zero, if possible.”
WATCH: I Have Stage Zero Breast Cancer.
Stage Zero Breast Cancer
Stage zero breast cancer or ductal carcinoma in situ are abnormal cells that line the duct in a breast. A normal breast comprises many ducts carrying milk to the nipple in a lactating woman. This type of breast cancer is not invasive, meaning it has not spread outside the milk duct and can’t invade other parts of the breast.
Some oncologists approach stage zero breast cancer with a watch-and-wait approach, meaning no invasive procedure happens immediately. Other oncologists may opt to perform surgery followed by possible radiation.
SurvivorNet experts say if DCIS is left untreated, it may develop into more advanced breast cancer.
However, it’s important to understand that treatment for early-stage breast cancer is one of the great debates—and recently, there was incredible progress in understanding whether women diagnosed with stage zero breast cancer either need treatment right away or can take a watch-and-wait approach.
A study recently published in JAMA Oncology, is saying that treatment for the disease is actually no better than active surveillance after a stage zero diagnosis.
More Resources On Stage Zero or Early-Stage Breast Cancer
The research, shared in JAMA with the title “Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ – The COMET Randomized Clinical Trial,” is a large study that’s been looking into the benefit of active surveillance versus standard treatment.
As the COMET trial, which has been going on for years and is still underway, those who specialize in breast cancer say this study is incredibly important. Including, Dr. Ann Partridge, an oncologist at Dana-Farber Cancer Institute and the founder and Director of the Program for Young Women with Breast Cancer, who previously told SurvivorNet that DCIS is “a pre-cancer, technically.”
The standard treatment for DCIS is to remove it surgically and in some instances offer radiation as well. “But I think if a woman is seeing a physician who says you need surgery, I think it’s really important that she maybe get a little more information,” Dr. Partridge said.
This type of research has been put into place to help doctors decide whether doing less may be just as effective as doing more. In the meantime, the options are worth weighing depending on your individual diagnosis and concerns.
And we understand that these findings can be distressing to women who have already undergone surgery, chemotherapy, and/or radiation for early-stage breast cancer, it’s important to note that approximately 30 percent of women who initially receive an early-stage breast cancer diagnosis will end up developing metastatic breast cancer, according to the National Breast Cancer Foundation.
Additionally, Breast Cancer Research Foundation reports that women with stage zero breast cancer have a a high success rate of beating the disease, with a 98 percent survival rate after 10 years.
Dr. Partridge explained to SurvivorNet that stage zero breast cancer is, “Something that may turn into invasive breast cancer. Invasive breast cancer is the kind of breast cancer that has the potential to not only grow in your breast but to spread to other places in the body and ultimately hurt someone more than just needing a breast surgery.”
The current standard of care is treatment with either lumpectomy or mastectomy, radiation, and hormonal therapy.
Additionally, Dr. Chirag Shah, Director of Breast Radiation Oncology at the Cleveland Clinic Cancer Center, says recent studies show that the risk of dying from stage zero breast cancer is very low, prompting some doctors to opt for less aggressive treatment and, even in some cases, active surveillance.
“Protocols, such as the comet trial, are studying the use of surveillance regimens, but this is not standard of care and is experimental at this time, and active surveillance is not something that we would recommend for patients outside of a clinical study,” Dr. Shah said.
Finding a Balance Between Screening and Treating
Dr. Alana Welm, of the Huntsman Cancer Institute, also told SurvivorNet that doctors need to find a balance between screening and finding cancers that actually require treatment.
Screenings lead to more people being diagnosed with cancer, and some of those cancers may have never caused an issue. Dr. Welm says treating these cancers exposes patients to unnecessary toxicities. Stage zero breast cancer, for example, can get picked up during screening but not all doctors see eye-to-eye on whether it requires treatment or just monitoring.
WATCH: Understanding a double mastectomy.
Coping With Your New Body After Cancer Treatment
To prepare yourself for possible body changes during cancer treatment is to understand that changes are possible but also temporary. This can also help build up your self-confidence. Your support group, filled with loved ones, can help you during this stage of your journey.
Psychologist Dr. Marianna Strongin shares with SurvivorNet some additional tips cancer warriors can explore to help manage the emotional toll body changes can have during treatment.
Dr. Strongin encourages cancer warriors to take ownership of the part (or parts) of their body impacted mainly by cancer treatment. She says although they may represent “fear and pain,” they also represent “strength and courage.”
WATCH: Regaining your sense of self after reconstruction.
“Research has found that when looking in the mirror, we are more likely to focus on the parts of our body we are dissatisfied with, which causes us to have a negative self-view and lower self-esteem. Therefore, I would like you first to spend time gazing at the parts of your body you love, give them time, honor them, and then thank them,” Dr. Strongin said.
Dr. Strongin then suggests looking at the part or parts of your body impacted by the cancer or cancer treatment. She recommends creating a regular practice of accepting your body image because it helps you accept your cancer journey emotionally and physically.
“As you allow yourself to spend more time looking at all of you, you will begin having a new relationship with your body. It may not happen immediately, but with time, you can begin honoring and thanking your new body,” Dr. Strongin added.
Breast Cancer Screenings
As for breast cancer screenings, a mammogram is the primary test doctors use to check for breast cancer. The wide consensus is that women should have regular mammograms beginning in their 40s.
Leading organizations like the American Cancer Society say women should have the option to begin annual screenings between 40 and 45. An independent panel of experts called the U.S. Preventive Services Task Force recently changed their guidelines to say that women of average risk should begin at 40 and get mammograms every other year.
Dr. Connie Lehman, a diagnostic radiologist who specializes in breast cancer at Massachusetts General Hospital in Boston, says when you begin mammograms is a decision you should discuss with your doctor, as they can help you understand your specific circumstances and weigh the benefits and potential risks of earlier screening.
Follow That Fire: Life After Cancer Will be Different, That Doesn’t Have to be a Bad Thing
Your mammogram results may lead your doctor to recommend further testing with a diagnostic mammogram, ultrasound, or magnetic resonance imaging (MRI). If these tests suggest changes that might be cancer, you’ll need a biopsy a test in which your doctor removes a small sample of tissue and has it checked for cancer in a lab.
Only a biopsy can confirm or rule out whether you have breast cancer.
Although it can be frightening to go through breast cancer testing, SurvivorNet’s doctors say not to fret. It’s possible for a biopsy to find that a lump is benign or not cancerous.
If you do receive a breast cancer diagnosis, you’ll learn what type of breast cancer you have and the stage of the disease. The stage means how far in your body the cancer has spread.
Though most breast cancers are not linked to inherited genetic mutations, knowing whether you have a mutation could affect the type of treatment you get. SurvivorNet experts recommend all women who are diagnosed with breast cancer be given genetic testing.
Based on your test results, preferences, and personal circumstances (such as your age), you and your doctor will make decisions about how to proceed with treatment, which we have plenty of expert resources on.
Contributing: SurvivorNet Staff
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