Too much chemo. Too much radiation. And way too many mastectomies
“What if I decide to just do nothing?”
It was kind of a taunt, Desiree Basila admits. Not the sort of thing that usually comes out of the mouth of a woman who’s just been diagnosed with breast cancer. For 20 minutes she’d been grilling her breast surgeon. “Just one more question,” she kept saying, and her surgeon appeared to her to be growing weary. She was trying to figure out what to do about her ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer, and she was already on her second opinion. The first surgeon had slapped a photograph of her right breast onto a viewer, pointed to a spot about 5 cm long and 2.5 cm wide and told her there was a slot open the following week for a mastectomy.
Basila’s first reaction to her diagnosis was an animal-instinct panic that she registered as “10,000 bricks” crushing into her chest when she woke up in the morning. After that, Basila, who is now 60 and teaches high school science in San Francisco, did a little research. She learned that there were a lot of unknowns about the progression of DCIS, which is noninvasive–it’s confined to the milk ducts–and is the earliest stage of breast cancer. She also learned there was some disagreement in the field about how to treat it.
She knew she wasn’t ready to have one or both of her breasts cut off. And she wasn’t sure she wanted a lumpectomy either. That’s why when Dr. Shelley Hwang, then a surgeon at the University of California, San Francisco (UCSF), recommended a lumpectomy, Basila grew frustrated. She was coat in hand and ready to walk out the door when she issued that half taunt. And when she did, Hwang said this: “Well, some people are electing to do that.”
Basila sat back down, and as their meeting reached the hour mark, she made a choice that humans are practically hardwired not to make in the face of a cancer diagnosis: she decided to do nothing.
Well, not nothing, exactly. She would start taking a drug called tamoxifen that blocks estrogen, which can fuel tumor growth, and she would enroll in a clinical trial involving active surveillance: twice-a-year visits in which she would get mammograms alternating with MRIs. As long as there were no worrisome changes, Basila would be spared the standard arsenal in breast-cancer treatment: surgery, radiation and chemotherapy.
That conversation took place eight years ago. And if it sounds radical today, it was all but heresy back then. This was before the U.S. Preventive Services Task Force said in 2009 that women should start mammograms at 50, not the previous guideline of 40, because there’s insufficient evidence that earlier screening does more good than harm.