Understanding Stage Zero Breast Cance
- Danielle Fishel, who battled stage 0 breast cancer, has showed off her sense of humor in a playful post-Halloween Instagram video, jokingly “following doctor’s orders” to cut back on sugar.
- Fishel previously shared that she was diagnosed with stage zero breast cancer after undergoing a routine mammogram and having no symptoms. She beat the disease after undergoing surgery, radiation, and daily medication.
- Stage 0 breast cancer refers to ductal carcinoma in situ (DCIS), in which abnormal cells are found in the lining of the breast’s milk ducts but haven’t spread into surrounding tissue. These ducts carry milk to the nipple when a woman is breastfeeding.
- The U.S. Preventive Services Task Force (USPSTF) recommends that women at average risk get a mammogram every other year from ages 40 to 74.
- If you have a higher risk for breast cancer due to family history or a genetic mutation, talk to your doctor about whether screening should start earlier or happen more often.
Just after Halloween, Fishel, who stays busy hosting on QVC with Lance Bass, co-hosting her Pod Meets World podcast and promoting her new book, “Book Meets World,” written with former castmates, shared a playful Instagram video reminding fans to “always follow doctor’s orders.”
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She fittingly set the clip to the band Fall Out Boy’s hit song “Sugar, We’re Goin Down.”
RELATED: Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
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Fishel also captioned the post, “Always follow doctor’s orders!” and fans were quick to join in on the joke.
“Time to get a new doctor!” one follower wrote in the most-liked comment, while another quipped, “I mean, technically, you are lowering your sugar intake.”
Another fan called it “compliance if I ever saw it,” adding a laughing-face emoji.
Plenty of fans saw themselves in the clip. “Literally me eating my kids Halloween candy rn,” one admitted, as another joked, “How’d you get this video of me?”
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One fan living with diabetes showed some solidarity, writing, “I’m a diabetic, Danielle, I know exactly how that feels,” followed by laughing and heart emojis.
Another follower even offered a practical tip, warning, “Don’t eat Halloween candy at bedtime when you are fasting for bloodwork or your glucose test will be elevated.”
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While Fishel’s doctor may want her cutting back, sugar itself doesn’t directly cause cancer, according to Krista Maruschak, a registered dietitian at the Cleveland Clinic Cancer Center, who previously spoke with SurvivorNet. The bigger concern is its effect on weight, since eating too much can lead to weight gain and obesity, a major risk factor for cancer and other chronic illnesses.
For patients currently undergoing cancer treatment, though, most doctors say keeping weight on is the top priority, even if that means indulging in the occasional sweet treat.
Sugar Doesn’t Cause Cancer — But Be Cautious
Fishel’s comical candy post came shortly after she marked a sweeter milestone: her eighth wedding anniversary with husband Jensen Karp.
Alongside a carousel of photos from their big day, she looked back on their “moody” downtown Los Angeles wedding, describing it as “fun, delicious, and filled with so much love and personality,” with plenty of laughs courtesy of Karp’s “hilarious vows.”
“We’re so lucky to have the village we do and lucky to have each other and our insanely wild kids,” she wrote. “No one I’d rather run this circus with.”
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Fishel’s Stage Zero Breast Cancer Diagnosis
“I was diagnosed with high-grade DCIS (ductal carcinoma in situ) with micro-invasion,” Fishel previously said on the Pod Meets World podcast, which she and co-stars Rider Strong and Will Friedle host while reliving classic episodes.
Fishel said she underwent surgery to remove the cancer and received follow-up treatment.
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After her diagnosis, Fishel felt increasingly empowered to share her cancer journey.
Grateful her annual mammogram caught the cancer early, Fishel hopes her journey inspires others to take charge of their own health.
“What I realized is the more people I talk to, the more people have had their own experiences, either themselves being diagnosed with cancer or a family member who’s been diagnosed with cancer,” Fishel said.
“If it’s time for your appointment, if you’ve never had an appointment before, get in there. If you have to find out that you have cancer, find out when it’s at stage zero, if possible.”
WATCH: I Have Stage Zero Breast Cancer.
Understanding Early-Stage Breast Cancer
Stage zero breast cancer, or ductal carcinoma in situ (DCIS), is made up of abnormal cells that line a duct in the breast. A normal breast contains many ducts that carry milk to the nipple in a lactating woman. DCIS is not invasive, meaning it has not spread outside the milk duct into other parts of the breast.
Fishel’s diagnosis was slightly different. “Micro-invasion” means that in at least one tiny spot, measuring no more than a millimeter, the abnormal cells had begun to break through the duct wall. Even so, microinvasive disease is still considered very early and highly treatable, and it’s generally treated with surgery rather than monitoring.
WATCH: I Have Stage Zero Breast Cancer: What Should I Do?
SurvivorNet experts say that if DCIS is left untreated, it may develop into a more advanced breast cancer. Dr. Ann Partridge, an oncologist at Dana-Farber Cancer Institute and the founder and director of the Program for Young Adults with Breast Cancer, has told SurvivorNet that DCIS is “a pre-cancer, technically.”
She explained that stage zero breast cancer is “something that may turn into invasive breast cancer. Invasive breast cancer is the kind of breast cancer that has the potential to not only grow in your breast but to spread to other places in the body and ultimately hurt someone more than just needing a breast surgery.”
The current standard of care for DCIS is surgery, either a lumpectomy or mastectomy, sometimes followed by radiation and hormone therapy. The good news is that the outlook is excellent: according to the Breast Cancer Research Foundation, women with stage zero breast cancer have a 98 percent survival rate after 10 years.
The Debate Over Treating Low-Risk DCIS
How aggressively to treat DCIS remains one of the big debates in breast cancer care, and a major 2024 study added new evidence.
The COMET trial compared active monitoring, meaning breast imaging and exams every six months, with standard treatment of surgery with or without radiation. The trial enrolled women 40 and older with low-risk, hormone receptor-positive grade 1 or 2 DCIS. Results were presented at the San Antonio Breast Cancer Symposium in December 2024 and published in JAMA.
After two years, the risk of developing invasive breast cancer was nearly the same in both groups: 4.2 percent with active monitoring and 5.9 percent with standard care. A separate analysis published in JAMA Oncology found that women under active monitoring reported similar physical, emotional and psychological outcomes to those who had upfront treatment.
Still, the findings come with important caveats. Researchers acknowledged that more invasive cancers may show up with longer follow-up, particularly in the monitoring group, and further analyses are planned at 5, 7 and 10 years. The women in the trial had a median age of about 64, and treatment decisions depend on the specifics of each patient’s diagnosis.
Fishel’s high-grade, microinvasive diagnosis also wouldn’t have qualified for the trial, which was limited to low-risk DCIS.
“But I think if a woman is seeing a physician who says you need surgery, I think it’s really important that she maybe get a little more information,” Dr. Partridge said.
Dr. Chirag Shah, director of breast radiation oncology at the Cleveland Clinic Cancer Center, says recent studies show the risk of dying from stage zero breast cancer is very low, which has led some doctors to consider less aggressive treatment. But he cautions that monitoring alone isn’t yet standard practice.
“Protocols, such as the COMET trial, are studying the use of surveillance regimens, but this is not standard of care and is experimental at this time, and active surveillance is not something that we would recommend for patients outside of a clinical study,” Dr. Shah said.
Finding a Balance Between Screening and Treating
Dr. Alana Welm of the Huntsman Cancer Institute has told SurvivorNet that doctors need to strike a balance between screening and identifying cancers that actually require treatment.
Screening leads to more cancer diagnoses, and some of those cancers may never have caused a problem. Dr. Welm says treating them can expose patients to unnecessary side effects. Stage zero breast cancer is often picked up through screening, and doctors don’t always agree on whether it needs treatment or monitoring.
The Importance of Laughter & Positivity
Like many survivors who turn to humor, Fishel continues to embrace adversity with optimism, without losing her sense of self. That instinct may do more than lift her spirits: research indexed by the National Library of Medicine suggests that patients who watch funny movies need less pain medication.
Learn to Accept Yourself — A Huge Part of Living With Cancer
Another example of the importance of positivity amid tough times comes from stand-up comedian Jesus Trejo in Long Beach, California.
Trejo became a caregiver for both of his parents after his mother was diagnosed with a cancerous brain tumor and his father was later diagnosed with colon cancer. But instead of panicking and focusing on the devastating situation, the only child stepped up to care for his parents with love and laughter.
In a previous interview with SurvivorNet, Trejo opened up about putting his career aside to care for his parents in their time of need, while still making time to smile along the way.
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“The only advice I have for anyone watching this is laugh, and laugh often, laugh at yourself. Don’t take yourself seriously. Things are already bad. Because once you do that, it’s a game-changer,” Trejo told SurvivorNet.
He also says the laughter itself might be brief, but “the effects of it just reverberate through your body, and can change an already bad situation into a better one.”
While a positive outlook can’t cure cancer, some SurvivorNet experts say they’ve seen how it can help patients cope with treatment and enjoy a better quality of life.
Dr. Zuri Murrell, of Cedars-Sinai, told SurvivorNet in an earlier interview, “My patients who thrive, even with stage 4 cancer, from the time that they, about a month after they’re diagnosed, I kind of am pretty good at seeing who is going to be OK. Now that doesn’t mean I’m good at saying that the cancer won’t grow.”
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“But I’m pretty good at telling what kind of patients are going to still have this attitude and probably going to live the longest, even with bad, bad disease. And those are patients who have gratitude in life.”
Meanwhile, Dr. Dana Chase, a Gynecologic Oncologist at UCLA Health, also says it’s important to focus on the good, stay positive, and do things that bring you joy to the degree you’re able to amid battling a disease like cancer.
“We know, actually from good studies, that emotional health, quality of life is associated with survival, meaning better quality of life is associated with better survival, better outcomes,” Dr. Chase said in an earlier interview.
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Helping You With Questions For Your Doctor
To further help you on your cancer journey, explore SurvivorNet’s proprietary AI tool, “My Health Questions.” This powerful resource can help you come up with helpful questions to ask your care team for an upcoming appointment, and it offers so much more.
WATCH: How One Cancer Survivor and Her Sister Used “My Health Questions” to Navigate Care
This powerful resource, embedded across the SurvivorNet website, bridges that gap by offering on-demand explanations of treatment options, clinical trials, side effects, insurance concerns, and more.
Users can ask questions conversationally, either by typing or using their voice, and receive answers tailored to their individual profiles. If patients don’t know where to start, we provide prompt questions to get them started.
Contributing: SurvivorNet Staff
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