By Emily Willingham 
 
 HealthDay Reporter 
 
 THURSDAY, Aug. 20, 2015 (HealthDay News) -- Only 3 percent of women diagnosed with an early stage of breast cancer will die of their disease within 20 years, and more aggressive treatment does not improve that high survival rate, a new study suggests. 
 
 "The good news is that death is pretty rare," said study first author Steven Narod, director of the Familial Breast Cancer Research Unit at Women's College Research Institute, in Toronto. "Clinically, the fact is that 3 percent in the big picture should be reassuring." 
 
 The researchers did find that the death rates for both younger women and black patients diagnosed with this early stage cancer were higher. 
 
 The early stage breast cancer that they studied is ductal carcinoma in situ (DCIS), a small, localized cluster of cancer cells. About 20 to 25 percent of breast cancers that mammogram screening detects are DCIS. It is considered a stage 0 cancer that does not escape its location in the breast, the researchers said. Cancer that spreads into the rest of the breast or beyond is considered invasive. 
 
 "One clinical implication is to reiterate that DCIS is not an 'emergency,' " said Sarah Hawley, a cancer research specialist at the University of Michigan in Ann Arbor. "The study supports that the risk of dying is extremely low for these patients." 
 
 Narod and his co-authors combed through a database of information on slightly more than 108,000 women who had been diagnosed with DCIS between 1988 and 2011. They compared these patients' risk of dying from breast cancer with the risk for women in the general population. On average, the women were 54 years of age when they received their DCIS diagnosis, and the authors followed their outcomes for an average of 7.5 years. The team then estimated overall death rates at 10 and 20 years. 
 
 In all, 956 women in the study ultimately died of breast cancer. Of those, 517 never had invasive cancer in the breast after treatment seemed to cure their DCIS. That means that the cancerous breast cells from their DCIS had escaped at some point and survived in the lungs or bone, later developing into a deadly cancer, Narod explained. 
 
 The study authors also found that women with a history of DCIS had about the same rates of invasive breast cancer in either breast, not just the breast where the DCIS was detected. 
 
 Women with DCIS usually undergo either surgical removal of the cancerous area followed by radiation therapy, removal alone or complete removal of one or both breasts. The study authors found that the addition of radiation therapy did not appear to save any more lives compared to just surgery alone. 
 
 "The finding that radiation treatment did not impact survival for most DCIS patients suggests that alternatives to radiation should be considered, including omitting it altogether," Hawley said. 
 
 The findings were published online Aug. 20 in the journal JAMA Oncology. 
 
 Hawley noted that women under age 35 and black women had a higher risk of death from DCIS. In the broadest analysis, younger women had a mortality risk of almost 8 percent, and the risk for black women was 7 percent. 
 
 In an accompanying editorial, Laura Esserman and Christina Yau, both from the University of California, San Francisco, wrote that DCIS looks different in younger women, causing symptoms such as a detectable mass or bloody nipple discharge. Because screening in women under age 40 is rare, they said, these symptoms are usually how younger women end up on the clinical radar. 
 
 Some other risk factors for a rogue DCIS include whether or not it responds to hormones, carries certain versions of cancer-related genes or is 2 inches across or larger. 
 
 These risk factors have yet to lead to different treatments for younger women or black women who are diagnosed with DCIS. Hawley said that with further research, more targeted treatments might be possible for women who are at higher risk. 

 Importance Women with ductal carcinoma in situ (DCIS), or stage 0 breast cancer, often experience a second primary breast cancer (DCIS or invasive), and some ultimately die of breast cancer. 
 
 Objective To estimate the 10- and 20-year mortality from breast cancer following a diagnosis of DCIS and to establish whether the mortality rate is influenced by age at diagnosis, ethnicity, and initial treatment received. 
 
 Design, Setting, and Participants Observational study of women who received a diagnosis of DCIS from 1988 to 2011 in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database. Age at diagnosis, race/ethnicity, pathologic features, date of second primary breast cancer, cause of death, and survival were abstracted for 108 196 women. Their risk of dying of breast cancer was compared with that of women in the general population. Cox proportional hazards analysis was performed to estimate the hazard ratio (HR) for death from DCIS by age at diagnosis, clinical features, ethnicity, and treatment. 
 
 Main Outcomes and Measures Ten- and 20-year breast cancer–specific mortality. 
 
 Results Among the 108 196 women with DCIS, the mean (range) age at diagnosis of DCIS was 53.8 (15-69) years and the mean (range) duration of follow-up was 7.5 (0-23.9) years. At 20 years, the breast cancer–specific mortality was 3.3% (95% CI, 3.0%-3.6%) overall and was higher for women who received a diagnosis before age 35 years compared with older women (7.8% vs 3.2%; HR, 2.58 [95% CI, 1.85-3.60]; P < .001) and for blacks compared with non-Hispanic whites (7.0% vs 3.0%; HR, 2.55 [95% CI, 2.17-3.01]; P < .001). The risk of dying of breast cancer increased after experience of an ipsilateral invasive breast cancer (HR, 18.1 [95% CI, 14.0-23.6]; P < .001). A total of 517 patients died of breast cancer following a DCIS diagnosis (mean follow-up, 7.5 [range, 0-23.9] years) without experiencing an in-breast invasive cancer prior to death. Among patients who received lumpectomy, radiotherapy was associated with a reduction in the risk of ipsilateral invasive recurrence at 10 years (2.5% vs 4.9%; adjusted HR, 0.47 [95% CI, 0.42-0.53]; P < .001) but not of breast cancer–specific mortality at 10 years (0.8% vs 0.9%; HR, 0.86 [95% CI, 0.67-1.10]; P = .22). 
 
 Conclusions and Relevance Important risk factors for death from breast cancer following a DCIS diagnosis include age at diagnosis and black ethnicity. The risk of death increases after a diagnosis of an ipsilateral second primary invasive breast cancer, but prevention of these recurrences by radiotherapy does not diminish breast cancer mortality at 10 years.
– An increasing number of women may be getting one or both breasts removed following a certain early stage breast cancer diagnosis without actually decreasing their odds of dying from the disease, the New York Times reports. A study published today comes to the conclusion that many thousands of women are getting "sometimes disfiguring" treatments unnecessarily after being diagnosed with DCIS, long considered a precursor of breast cancer. Advances in mammogram technology have increased diagnoses of DCIS—abnormal cells in the milk duct—from a few hundred a year in 1980 to 60,000 a year today. That increase in early DCIS detection should correspond to a decrease in breast cancer cases, but it hasn't. Researchers looked at more than 100,000 women with DCIS—almost all of whom had lumpectomies, mastectomies, or double mastectomies following their diagnosis—and concluded they had a 3.3% chance of dying of breast cancer in the next 20 years, the Times reports. That's about the same as any random woman off the street (though young and/or black DCIS patients had a slightly higher mortality rate), according to HealthDay. A doctor behind the study tells the Times it shows the best treatment for DCIS is to do nothing, and the American Cancer Society's chief medical officer says treatment of DCIS has been excessive. "In medicine, we have a tendency to get too enthusiastic," he says. Not everyone agrees. A chief breast cancer surgeon at one cancer center said she doesn't see a reason to change the current system.