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Many Tumors Detected by Mammography Are Noninvasive

About 20% of the tumors detected by mammography are noninvasive, meaning they have not progressed beyond the outermost layers of the ducts inside the breast, a new study shows.

This translates to one tumor for every 1,300 mammograms, researchers reported in the Journal of the National Cancer Institute.

Doctors aren’t sure how many of these noninvasive tumors, also called ductal carcinoma in situ (DCIS), would keep growing and start to spread, the study’s lead author, Virginia L. Ernster, a researcher at the University of California at San Francisco, noted. All DCIS are surgically removed after they are found.

In fact, "autopsy studies have shown that DCIS is not uncommon among women who died of causes unrelated to breast cancer", Ernster added, which "suggests that some cases of DCIS do not progress to clinically significant lesions and may never require treatment in the patient’s lifetime."

For this reason, she and her colleagues conclude, the significance of DCIS detected by mammography should be studied further, and methods for identifying disease that is likely to progress should be developed. Ernster and her team scrutinized the medical records of nearly 541,000 women, including results from roughly 654,000 mammograms. The women in the study were 40 to 84 years old.

Analysis of the findings also showed, the researchers note, that mammograms were actually better at finding DCIS than identifying invasive cancers.

The study shows the percentage of DCIS detected by mammography, but it shouldn’t change how doctors treat patients with this kind of tumor, Dr. Emily Conant, an associate professor of radiology and chief of the breast imaging section at the University of Pennsylvania School of Medicine, said in an interview.

"We’ve known for a while that mammography can detect pre-clinical tumors that are too small to be felt," Conant said. "The natural history of these tumors vary so much from woman to woman. Some, if left alone, might not harm anyone. But others are highly aggressive and can progress from this early form to and cause havoc. The dilemma is that we don’t know which ones will be aggressive."

That means that some women will have unnecessary surgery and, in some cases, radiation therapy, Conant said. But no one wants to miss a tumor that will become aggressive, she added.

"I think the take-home message is that mammography has been improving over the years and we are finding smaller and smaller tumors. Mortality due to breast cancer is dropping. Though we can’t say for sure how much of that is due to detection and how much is due to treatment, my view is not to give up on this screening method."

The ultimate solution, Conant said, is for researchers to find a way to tell the difference between aggressive and essentially benign cancers.