Women with a precancerous stage of breast cancer, DCIS
[Ductal carcinoma in situ], are now all treated as if they have
cancer. Pathologist Jelle Wesseling from the Netherlands
Cancer Institute has received a multimillion Euro grant and award
from Cancer Research UK and KWF [Dutch Cancer Society] (Grand
Challenge) to change this. Because: often DCIS does no harm and
therefore thousands of women all over the world are undergoing
unnecessarily severe treatments.
The British sister organization of the Dutch Cancer Society,
Cancer Research UK, has launched a major project to "tackle,
globally, key challenges in today's cancer research." Researchers
who came up with the best plan, could qualify for a Grand Challenge
of many millions of pounds to tackle these problems. Jelle
Wesseling from the Netherlands Cancer Institute is the leader of
one of the four winning teams. He receives no less than 15 million
pounds - nearly 17.5 million Euros - to solve the problem
affiliated with DCIS. Half of this money comes from CRUK, the other
half from the Dutch Cancer Society.
Thousands women have
DCIS, full ductal carcinoma in situ, a precancerous stage
of breast cancer. In the Netherlands alone, this condition is
diagnosed in several thousand women each year. In DCIS, there are
abnormal cells in the milk ducts in the breast. On scans, this can
be seen as calcium specks. Wesseling: "These abnormal cells may
become cancer if they grow from the milk ducts into the breast
tissue. But we now know that this often does not happen. Sometimes,
the abnormal cells grow very slowly. Moreover, DCIS cannot
metastasize. Therefore, in many cases, DCIS is actually harmless.
The big problem is: at present, we cannot distinguish between the
women with DCIS who will develop cancer, and those who will not.
That is what in my research is about: determining the distinction
between high-risk and low-risk DCIS, and thus, saving so many women
from an unnecessary, burdensome treatment."
Since it can not be predicted at this time which women are at
risk of having their DCIS develop into cancer, all women are now
treated as if they have it. "This treatment is pretty drastic,"
says Wesseling. "Women with DCIS now all receive surgery. And when
it is a lumpectomy, then radiation usually follows, as well. In
fact, these women are treated as if they have breast cancer. While
that is regularly not even necessary. We estimate, based on the
research that has been done so far, that DCIS will never develop
into cancer in 30 to 50 percent of cases."
The latter is a rough estimate. But it would mean that, at
present in Netherlands alone, hundreds of women are being
over-treated every year. Globally, this number is much higher. In
the US, for example, about 60,000 women a year are diagnosed with
DCIS. Thus, probably tens of thousands of women receive unnecessary
treatment. "My challenge here to change that," says Wesseling. "It
is important for women who need to be treated, to receive the
treatment they need. But also, for the women who do not, it is
important to save them from the physical and psychological burden
of this treatment."
Thanks to the Grand Challenge, Wesseling can now get to work as
the head of an international research team. The project will run
for five years.