Understanding Stage Zero Breast Cancer
- Fox News columnist Kat Timpf has gone public with her stage zero breast cancer, known as ductal carcinoma in situ (DCIS)—something she was diagnosed with just 15 hours before giving birth to her first child.
- Stage zero breast cancer refers to DCIS otherwise known as Ductal Carcinoma In Situ. DCIS are abnormal cells that line the duct in a breast. A normal breast comprises lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
- Timpf was told by her doctors that the best course of action to treat her cancer “would likely be a double mastectomy as soon as possible.”
- A study, recently published in JAMA Oncology, suggests stage zero breast cancer may not need treatment right away, and can instead take a watch-and-wait approach.
- Detecting breast cancer so tricky while pregnant is that the breast changes in appearance. These changes can easily be masked by the body’s natural response to pregnancy; thus, diagnoses usually come after the cancer has reached advanced stages.
Despite being diagnosed, Timpf has remained optimistic, telling others, “Don’t freak out. It’s just, like, a little bit of cancer.”
Read MoreShe wrote on X, formerly Twitter, and Instagram, “Now, before you worry, my doctor says it’s Stage 0 and is confident that it almost certainly hasn’t spread. Or, as I’ve explained to the few people I’ve managed to tell about it so far: Don’t freak out. It’s just, like, a LITTLE bit of cancer.View this post on Instagram
“Still, it was not a chill day. I mean, to say the least! I woke up more-than-a-week-past-due pregnant, completely consumed by doing everything I could to get the baby out. By the middle of the afternoon, I was waddling around from appointment to appointment, talking about how to get my cancer out. I sat and listened as they told me that the best course of action would likely be a double mastectomy as soon as possible.”
Timpf explained further, “I asked all the questions I could, including if I could get a copy of my tumor ultrasound to put on the fridge next to the ultrasound of my baby. Finally, by the middle of the night, I was crawling around on the floor of my apartment in spontaneous labor, before heading to the hospital to meet my baby, whom I’d learn at the time of birth was a son.
“The good news? People who work at hospitals make excellent audiences for dark humor — and, as someone whose first book was about the power of jokes to get through traumatic situations, there was really no better place for me to be. Just minutes after my boy was born, I was talking with the nurses about what a birth announcement in my situation might look like. Should I go with ‘Mom and baby are doing well, except maybe for mom’s cancer, and then maybe the baby after breastfeeding is stunted by her double mastectomy,’ and then shut off my phone for a week?”
The five-foot-three new mom, who is married to Cameron Friscia, concluded, “Anyway! These next three months of maternity leave are going to look a lot different than I’d anticipated, and I’m still getting used to my new reality. Still, as I navigate new motherhood (and new cancer) I’m learning to celebrate everything I can.
“I’m lucky that we found the cancer so early; I’m lucky to be my son’s mom. I mean, I know I’m biased, but the little dude absolutely rules — and not just because he might have saved my life. Thank you all for your support, laughter, and love as I embrace this wildly unexpected chapter. Here’s to resilience, to miracles in the midst of chaos, and to finding humor and hope even on the toughest days.”
View this post on Instagram
Understanding Kat Timpf’s Early-Stage Breast Cancer Diagnosis
Stage zero breast cancer or ductal carcinoma in situ are abnormal cells that line the duct in a breast. A normal breast comprises many ducts carrying milk to the nipple in a lactating woman. This type of breast cancer is not invasive, meaning it has not spread outside the milk duct and can’t invade other parts of the breast.
Some oncologists approach stage zero breast cancer with a watch-and-wait approach, meaning no invasive procedure happens immediately. Other oncologists may opt to perform surgery followed by possible radiation.
WATCH: I Have Stage Zero Breast Cancer: What Should I Do?
SurvivorNet experts say if DCIS is left untreated, it may develop into more advanced breast cancer.
However, it’s important to understand that treatment for early-stage breast cancer is one of the great debates—and recently, there was incredible progress in understanding whether women diagnosed with stage zero breast cancer either need treatment right away or can take a watch-and-wait approach.
A study recently published in JAMA Oncology, is saying that treatment for the disease is actually no better than active surveillance after a stage zero diagnosis.
The new research, shared in JAMA with the title “Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ – The COMET Randomized Clinical Trial,” is a large study that’s been looking into the benefit of active surveillance versus standard treatment.
As the COMET trial, which has been going on for years and is still underway, those who specialize in breast cancer say this study is incredibly important. Including, Dr. Ann Partridge, an oncologist at Dana-Farber Cancer Institute and the founder and Director of the Program for Young Women with Breast Cancer, who previously told SurvivorNet that DCIS is “a pre-cancer, technically.”
The standard treatment for DCIS is to remove it surgically and in some instances offer radiation as well. “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.
This type of research has been put into place to help doctors decide whether doing less may be just as effective as doing more. In the meantime, the options are worth weighing depending on your individual diagnosis and concerns.
And we understand that these findings can be distressing to women who have already undergone surgery, chemotherapy, and/or radiation for early-stage breast cancer, it’s important to note that approximately 30 percent of women who initially receive an early-stage breast cancer diagnosis will end up developing metastatic breast cancer, according to the National Breast Cancer Foundation.
Additionally, Breast Cancer Research Foundation reports that women with stage zero breast cancer have a a high success rate of beating the disease, with a 98 percent survival rate after 10 years.
Helping Patients Cope with Early-Stage Breast Cancer
- Introduction to Early-Stage Breast Cancer
- Early Stage Breast Cancer: What to Know About Testing
- Updated Guidelines on Biomarkers for Early-Stage Breast Cancer
- Hope For Some Early-Stage Breast Cancer Patients: Verzenio
- How Does Molecular Testing Help Determine the Best Breast Cancer Treatment Option?
- Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
- Surgery or Chemo First? How is Breast Cancer Treatment Order Determined
Dr. Partridge explained to SurvivorNet 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 is treatment with either lumpectomy or mastectomy, radiation, and hormonal therapy.
Additionally, Dr. Chirag Shah, Director of Breast Radiation Oncology at the Cleveland Clinic Cancer Center, says recent studies show that the risk of dying from stage zero breast cancer is very low, prompting some doctors to opt for less aggressive treatment and, even in some cases, active surveillance.
“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, also told SurvivorNet that doctors need to find a balance between screening and finding cancers that actually require treatment.
Screenings lead to more people being diagnosed with cancer, and some of those cancers may have never caused an issue. Dr. Welm says treating these cancers exposes patients to unnecessary toxicities. Stage zero breast cancer, for example, can get picked up during screening but not all doctors see eye-to-eye on whether it requires treatment or just monitoring.
What to Know About Screening For Breast Cancer
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
WATCH: Screening for Breast Cancer
For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women who have a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
Understanding the BRCA Gene Mutation
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
RELATED: Is Genetic Testing Right for You?
Different types of genetic testing can help people with a family history of cancer better ascertain their cancer risks. Your doctor will discuss your family history of cancer with you in the context of your type of tumor and your age at diagnosis. Hereditary genetic testing is usually done with a blood or saliva test.
The second test involves the genetic sequencing of your tumor if you’ve been diagnosed with cancer by this point. These genetic changes can be inherited, but most arise during a person’s lifetime. This process usually involves examining a biopsy or surgical specimen of your tumor. This testing can lead to decisions on drugs that might work against your cancer.
WATCH: Understanding genetic testing for breast cancer.
About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center.
“We encourage only those who have a family history to really get [genetic testing],” Dr. Ginsburg previously told SurvivorNet.
“I would say that if you have anyone in your family who was diagnosed with a very rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome,” Dr. Ginsburg adds.
When You’re Getting a Mammogram, Ask About Dense Breasts
Treating Breast Cancer
For anyone battling breast cancer, it’s important to understand that your doctor has many ways to treat breast cancer, including:
- Surgery
- Chemotherapy
- Radiation
- Hormone therapy
- Targeted therapy
- Immunotherapy
“It’s important to understand why your doctor is recommending a particular type of treatment,” Johns Hopkins Kimmel Cancer Center’s Dr. Jessica Tao previously told SurvivorNet.
Breast Cancer: Introduction to Prevention & Screening
Surgery
Most women with breast cancer will have surgery at some point in their treatment. Depending on how far your cancer has spread and your personal preferences, you and your doctor may decide to:
- Remove just the cancer and an area of healthy tissue around it (lumpectomy)
- Remove one breast (mastectomy)
- Remove both breasts (double mastectomy)
- Removing your breasts can have a dramatic effect on your self-esteem, which is why some women who opt for a mastectomy then choose breast
- reconstruction surgery. This is a highly personal choice, and there is no “right” answer as to whether or not to reconstruct.
Chemotherapy
Chemotherapy uses strong drugs to kill cancer all over the body. You may get this treatment to shrink a tumor before surgery, afterward to get rid of any remaining cancer cells, or on its own if you can’t have surgery.
Whether or not to have chemotherapy can also be a choice, depending on a woman’s age, type of cancer, and stage.
Radiation Therapy
Radiation therapy is the use of high-energy rays to destroy cancer cells and is typically used after surgery to lower the chance that the cancer will come back after treatment. Many women undergo radiation as part of their treatment, especially if they opt for a lumpectomy instead of a mastectomy.
Hormone Therapy
The hormones estrogen and progesterone help some breast cancers grow. Doctors refer to these types of cancers as hormone-receptor-positive breast cancers. Receptors are proteins on the surface of breast cells that receive messages from estrogen, progesterone, or both, telling them to grow. Treatments that block these hormones may help stop the tumor.
Testing the tumor sample from a biopsy helps to determine whether hormone therapies such as tamoxifen (Nolvadex) or anastrozole (Arimidex) might work against the cancer. Women with breast cancer that is fueled by estrogen may take one of these drugs as part of their treatment.
Immunotherapy and Targeted Therapy
Immunotherapy and targeted therapies are newer forms of treatment. Immunotherapy boosts your body’s own immune response to help it stop the cancer.
As their name suggests, targeted therapies target certain substances that help the cancer grow. For example, drugs like trastuzumab (Herceptin) and pertuzumab (Perjeta) treat breast cancers that have too much of a protein called HER2 on their surface.
Deciding the Right Course of Breast Cancer Treatment
Doctors treating breast cancer seek out markers on your particular cancer to help decide what course of treatment is best for you. This is due to the cancer cells possibly having what are known as receptors that help identify the unique features of the cancer.
The three main receptors are the estrogen receptor, the progesterone receptor, and the HER2 receptor. The estrogen and progesterone receptors go together because they are fueled by hormones. Think of the cancer cell as having little hands on the outside of the cell which grabs hold of proteins that help it grow. These proteins are sometimes called “ligands.”
An example of a type of ligand that can stimulate a cancer cell is the hormone estrogen. An estrogen receptor-positive breast cancer will be stimulated by estrogen to grow. In this instance, your doctor may offer you treatment to specifically target the estrogen receptor.
The Unique Features of Breast Cancer
Another important receptor to test for is the HER2 receptor. For HER2 positive breast cancers (like the stage zero cancer Macpherson was diagnosed with), therapies that uniquely target the HER2 receptor are essential to treating the disease.
Figuring Out If You’re Ready to Share Your Diagnosis
Some people battling a disease or cancer are open to sharing their experiences as much as they can, while others prefer to keep it to themselves or close loved ones. SurvivorNet experts say both approaches and everything in between, are valid.
WATCH: Sharing a Diagnosis
“Patients who have just been diagnosed with cancer sometimes wonder how they are going to handle the diagnosis of the cancer in social situations,” psychiatrist Dr. Lori Plutchik explains.
Plutchik says patients consider questions like “How much information should they share and with whom should they share the information?”
Dr. Plutchik explains, “There is no one right way to handle this diagnosis. People should do what feels right to them.”
A cancer journey can last months to years, which means cancer warriors may be experiencing a lot of uncertainty until they fully understand where their health stands. This uncertainty can influence when a cancer patient is ready to share their diagnosis, Dr. Plutchik further explained.
Dr. Plutchik stresses that those close to a person going through cancer should be respectful of their wishes when it comes to disclosing their diagnosis and seeking support.
Cancer Treatment’s Potential Impact on Fertility for Men and Women
Cancer treatments like chemotherapy can damage sperm in men, and hormone therapy can decrease sperm production, according to the National Cancer Institute. Radiation treatment can also lower sperm count and testosterone levels, impacting fertility. These possible side effects of cancer treatment should be discussed with your doctor before starting treatment. For male cancer patients, men may have the option to store their sperm in a sperm bank before treatment to preserve their fertility.
This sperm can then be used later as part of in vitro fertilization (IVF), a procedure in which a woman’s egg is fertilized with sperm in a lab. The embryo is then transferred to a woman’s uterus to develop.
WATCH: Fertility after Cancer
Just as cancer treatment can impact men’s fertility, women may also be affected. Some types of chemotherapy can destroy eggs in your ovaries, making it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the drug type and age since your egg supply decreases with age.
“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.
Radiation to the pelvis can also destroy eggs. It can damage the uterus, too. Surgery to your ovaries or uterus can hurt fertility as well.
Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment.
If you have a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
Research shows that women who have fertility preserved before breast cancer treatment are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Most women preserve their fertility before cancer treatment by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor specializing in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these approaches:
- Ovarian tissue freezing is an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment immediately and don’t have time to harvest eggs.
- Ovarian suppression prevents the eggs from maturing so they cannot be damaged during treatment.
- For women getting radiation to the pelvis, Ovarian transposition moves the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy (ET) to try to get pregnant, and they did not have worse short-term recurrence rates than people who did not stop endocrine treatment.
Contributing: SurvivorNet Staff
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