My first consultation yesterday was with a woman who was diagnosed with Stage I breast cancer.  The diagnosis came from a mammogram.  It was seen as a suspicious reading and suspected DCIS, ductal carcinoma in situ.  She was sent to see a surgeon.

Instead of performing a biopsy, the surgeon’s recommendation was a double mastectomy.  Thinking I heard wrong, I asked, “What was the surgeon’s recommendation?”  The answer again, “A double mastectomy.”  As unbelievable as that may seem, I can only take the patient at her word.  In twenty-seven years of this work, this recommendation is the most egregious case of over-treatment I have experienced.

We spoke about other options.  I explained that there is an ongoing debate in the medical community regarding the question, “Is DCIS really cancer?”  This question is raised because DCIS very often self-resolves.  What appears to be suspicious on one mammogram is often not found on subsequent tests.  It’s the body’s natural ebb and flow, not dissimilar in concept to the common cold which often resolves of its own accord.

But DCIS is treated as cancer by orthodox medicine.  The traditionalists insist that since we cannot tell with certainty which suspicious cells may become cancer and which may not, we must treat all DCIS.  Even watchful waiting, now being more frequently called “active surveillance,” is considered ill-advised.

I recently posed this question to a young surgeon.  Her response was, “I treat all suspicious lumps aggressively.”  She went on to say that her approach—urging women to have a lumpectomy with no biopsy, followed by radiation and chemotherapy when malignancy is found—gives women peace of mind.  “They come to me after hearing about a suspicious spot on a mammogram.  I have a treatment plan that puts their mind at ease.”

One of the dirty little secrets of U.S. health care is that no standards of care are enforced across disciplines.  And if you have insurance, you will almost certainly get too much treatment.  And in the case of DCIS, more is not better.  That treatment strategy leads to massive overtreatment.

You have choices.  Get a second opinion, a third if needed.  Nancy Bell, RN, a clinical practice specialist in California recently wrote, “We’re not going to tell you your doctor is incompetent, but if I say, ‘You have the right to a second opinion,’ that can be code for ‘I don’t like your doctor’ or ‘I don’t trust your doctor.’”

You do have choices—especially in the case of DCIS.  Exercise them.