When your doctor tells you that you have 'Stage 0' breast cancer, you may feel both scared and curious. Is this really cancer? Or is it a precursor to cancer? What happens next? A thousand questions like these may be running through your mind. Don't worry, it's very normal. Let's talk about this very simply, in a way that you can understand.
What exactly is Stage 0 breast cancer?
To be honest, there are some opinions among doctors about this. Some experts consider this to be the first stage of breast cancer. Others think it is a precancer stage.
Simply put, cancer is the uncontrolled division of abnormal cells. These cells can invade surrounding healthy tissue. However, in Stage 0 breast cancer, these abnormal cells do not spread (`non-invasive`). This means that the cells remain where they started and have not spread to surrounding tissue. However, there is a chance that they could do so in the future. This is a less advanced stage than Stage I cancer.
There are two main types of stage 0 breast cancer .
1. Noninvasive Paget's disease: This is a very rare condition. It is a cancerous condition that occurs in the nipple.
2. Ductal Carcinoma in Situ (DCIS): This is what we often refer to when we talk about Stage 0 breast cancer. In this case, abnormal cells grow only inside the milk ducts in your breast. Importantly, these cells have not yet spread outside the ducts, which is where most of the breast fat tissue is located.
The exact cause of DCIS is not yet known. Many people do not experience any symptoms. However, sometimes a small lump may be felt or a bloody discharge may appear from the nipple .
These abnormal cells may or may not develop into invasive cancer. No one can predict exactly when this will happen. That is the biggest challenge in this situation.
Does this need to be treated? How do I make the decision?
After you are diagnosed with DCIS, it is given a grade in the pathology report you receive.
- Nuclear grade 3: This is the type with the highest potential for spread.
- Nuclear grade 1: This has a very low chance of spreading.
You will also be tested to see if your cancer cells have estrogen receptors. Your doctor may call this "ER-positive" or "ER+." If so, it means your cancer may grow more slowly.
In the meantime, your doctor may also suggest genetic testing, which can find out if you have any changes in your genes that increase your risk of breast cancer .
What you do next depends on all of these factors, as well as your personal preferences .
Most doctors believe that it is better to have some treatment because even if Stage 0 cancer does not spread, it may change in the future. So, the saying, "It's better to be safe than sorry" applies here too.
There are three main treatment options. Let's look at them in a table.
| Treatment Option | Simply put... (Simple Explanation) |
|---|---|
| Lumpectomy | This involves surgically removing only the area with the abnormal cells and a small amount of healthy tissue around it. |
| Lumpectomy and radiation therapy | After the above surgery, radiation therapy is given to destroy any abnormal cells that may remain. |
| Mastectomy | This surgery removes the entire breast. It may be recommended if DCIS has spread throughout the breast or for other reasons. |
Should we wait a little longer without treatment? (Watchful Waiting)
This is a controversial topic. Some experts believe that a strategy called "watchful waiting," which means not treating it right away but monitoring the condition with regular tests, is a good option. About one-third of women with DCIS will develop cancer that spreads in the future.
So your doctor may suggest that you avoid immediate treatment and instead monitor the condition with regular screening tests.
This has both advantages and disadvantages. Think about it...
If you have surgery (perhaps with radiation therapy) early on, you may be able to avoid spreading cancer that never develops. On the other hand, you may have undergone a painful treatment for something that will never be a problem.
But if you decide to wait without surgery, and unfortunately your condition develops into a metastatic cancer, it may be a bit more serious (and harder to treat) when it's discovered.
This is a very personal decision. You and your doctor should make this decision together, after talking it over thoroughly. Share all your concerns and fears with your doctor.
Take-Home Message
- Stage 0 breast cancer, or DCIS, is a non-invasive condition. The abnormal cells are only inside the milk ducts.
- This condition may or may not develop into cancer in the future. It is impossible to tell in advance.
- Whether or not to undergo treatment, and what treatment to use, depends on a number of factors (cancer grade, ER status) and your personal preferences.
- The main options are surgery (`Lumpectomy` or `Mastectomy`), radiation therapy, or no treatment at all (`watchful waiting`).
- This is not a decision you should make alone. Talk openly and thoroughly with your doctor to make the decision that is best for you.
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