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What is 'Stage 0' breast cancer and how is it treated? [sciencenews.org]:

Actress Danielle Fishel made headlines last week when she announced that she had “very, very, very early” breast cancer.

“It’s technically Stage 0,” the Boy Meets World star said on her podcast, “Pod Meets World,” on August 19. She plans to have surgery to remove the cancer, “and I’m going to be fine,” she said.

Hearing such an optimistic story about a cancer diagnosis is heartening. But what exactly does “Stage 0 breast cancer” mean? Science News dug into the details.

What is Stage 0 cancer?

Stage 0 cancer is a condition where cells in the body look like cancer cells under a microscope but haven’t left their original location. It’s also known as carcinoma in situ or noninvasive cancer, because it hasn’t invaded any of the surrounding tissues. Sometimes it’s not even called cancer at all.

“A lot of people think of these as kind of precancer lesions,” says Julie Nangia, an oncologist at Baylor College of Medicine in Houston.

There are many different types of Stage 0 cancer, depending on which tissue or organ the cells are from. Some cancers, like sarcomas (cancers of the bones or skin), don’t have a Stage 0.

Fishel’s diagnosis is called ductal carcinoma in situ, or DCIS. This means some cells in the milk ducts in the breast look abnormal, but those cells haven’t grown outside the milk ducts and moved into the rest of the breast tissue.

The trouble is, they could. If the abnormal cells do break through the milk duct, the severity of the ensuing cancer can range from Stage 1 to the most advanced Stage 4, depending on how big the tumor is and how far the cancer has spread throughout the body.

How common is DCIS?

Before regular screening mammograms [sciencenews.org] became the norm, DCIS accounted for just 5 percent of breast cancer diagnoses, says breast cancer surgeon Sara Javid of the Fred Hutch Cancer Center in Seattle (SN: 6/13/14).

Now, DCIS accounts for about 20 percent of newly diagnosed breast cancers. About 50,000 cases are diagnosed in the United States every year, and it turns up in one out of every 1,300 mammograms.

Still, because Stage 0 breast cancer doesn’t really have any symptoms, it’s possible to have it and never notice. “A lot of women have DCIS and don’t know, especially older women, as it’s typically a disease of aging,” Nangia says.

For other Stage 0 cancers, the situation is different. Stage 0 cancers in other internal organs are often too small to show up on a scan [cancerresearchuk.org]. Widespread screening tests in other organs might be unsafe or take too many resources to run on a whole population.

The main exception is melanoma in situ, or Stage 0 skin cancer, which can be visible on the skin. That diagnosis is even more common than DCIS: Nearly 100,000 cases are expected in the United States in 2024.

How do you know if you have DCIS?

Most DCIS cases are caught by regular screening mammograms, the kind that people with breasts are encouraged to get annually starting at age 40 or 45. That’s how Fishel got her DCIS diagnosis.

“This is exactly why we want women to have screening mammograms,” Nangia says. “We want to catch cancer at its earliest stages where it’s incredibly easy to cure.”

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Journal Reference:
Just a moment..., (DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2214122 [doi.org])
Just a moment..., (DOI: https://ascopubs.org/doi/10.1200/JCO.2019.37.15_suppl.TPS603 [doi.org])
Just a moment..., (DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2214122 [doi.org])
Just a moment..., (DOI: https://ascopubs.org/doi/10.1200/JCO.2019.37.15_suppl.TPS603 [doi.org])

Original Submission