Stage 0 breast cancer and unnecessary treatment
Caroline Frean is a solicitor in the Enable Law medical negligence team. She represents clients who have been affected by unnecessary surgery and delays in diagnosis.
What is DCIS?
‘Stage 0 breast cancer’ or ‘pre-cancer’ are two names for ductal carcinoma in situ (DCIS). Treatment will often involve surgery such as mastectomy (removing the breast) and radiotherapy.
New research funded by Cancer Research and the Dutch Cancer Society has shown that many cases of DCIS will never become cancer at all. The worry is that some women with DCIS will have nasty side-effects from treatment they could have avoided.
In DCIS some of the cells in the lining of the ducts of the breast tissue have started to turn into cancer cells. The cancer cells are inside the ducts: they haven’t started to spread. DCIS may be diagnosed after finding a lump in the breast, breast pain or discharge. Sometimes it shows up in a routine mammogram. Around 6,300 women in the UK are diagnosed with DCIS every year.
Does DCIS always turn into breast cancer?
At the moment, doctors don’t know which cases of DCIS will become breast cancer and which won’t. So they often advise that women have treatment as it’s better to be safe than sorry.
In a big study being carried out in the Netherlands called the ‘Grand Challenge’, scientists are trying to find out how to tell which cases of DCIS will turn into cancer. The aim is for women to avoid unnecessary treatment that may be more harmful than the DCIS itself.
In the meantime, it is very important that patients with DCIS are given enough information. They need to know about the disease, the treatment options and the risks. Then they can make an informed choice.
DCIS and wrong treatment: A claim for damages
Ms D was offered a lumpectomy, (an operation to remove just the area of DCIS and some of the tissue around it), or mastectomy (an operation to remove the whole breast).
Ms D was very frightened to be told that she had ‘Stage 0 breast cancer’. She chose to have both breasts removed, because she didn’t want to risk that the DCIS would develop into invasive cancer. She asked to have breast implants put in during the same operation.
Ms D’s surgeon removed both breasts. He replaced them with breast implants, as Ms D had wanted.
Sadly, she had a very bad outcome. Both breasts became very badly infected. The infection wouldn’t respond to treatment. She became very ill. Her body rejected the breast implants. She was in pain and was very unhappy with the look of her breasts.
Ms D’s surgeon should have advised her that she didn’t need major surgery, especially not in the right breast as there hadn’t been any DCIS found there. A lumpectomy would have done the job just as well. He should have advised her that she was quite likely to have a bad result because she had several other health issues which made it more likely that she would develop infection, especially from implants. Unfortunately, Ms D’s surgeon didn’t give her very much information at all about options or the risks.
Because of her pain and infections, Ms D had to give up her job. She then found it very hard to find another job after being out of work for a few years.
Enable Law were able to settle Ms D’s claim for a sum which recognised her pain and suffering, the extra care her husband had to provide, and Ms D’s lost earnings.