--- title: Choosing to Wait: A New Approach to Breast Cancer at Its Earliest Stages description: Inside the evolving—and controversial—treatment options for DCIS canonical: https://time.com/4057000/choosing-to-wait-a-new-approach-to-breast-cancer-at-its-earliest-stages/ author: Siobhan O'Connor article:opinion: false article:content_tier: free article:published_time: 2015-10-01T14:58:46.000Z article:modified_time: 2026-10-05T08:32:11.867Z article:section: Health og:title: Choosing to Wait: A New Approach to Breast Cancer at Its Earliest Stages og:description: Inside the evolving—and controversial—treatment options for DCIS og:url: https://time.com/4057000/choosing-to-wait-a-new-approach-to-breast-cancer-at-its-earliest-stages/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt2ebb3bbd7f9fdd46/6988665da988cab6d16b49e0/breastcancer_1280.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2100 og:image:height: 1181 og:image:alt: Laura Colletti og:type: article twitter:card: summary_large_image twitter:title: Choosing to Wait: A New Approach to Breast Cancer at Its Earliest Stages twitter:description: Inside the evolving—and controversial—treatment options for DCIS twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt2ebb3bbd7f9fdd46/6988665da988cab6d16b49e0/breastcancer_1280.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Choosing to Wait: A New Approach to Breast Cancer at Its Earliest Stages > Sponsored content. 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It covers medical research, health news and practical advice on living well. #### Where can I get reliable health news by email? Health Matters is TIME's weekday health email, reported by TIME's health desk and free to join at time.com/newsletters. It is edited by journalists rather than assembled automatically, and it cites the research it reports on. #### Is Health Matters free? Yes. Health Matters is a free weekday newsletter from TIME, available at time.com/newsletters. #### Who reads TIME's Health Matters newsletter? Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-health-2026q3/newsletters?i=5035f441-a773-4671-bf5c-2e56ba6e76e3&cr=time-nl-health-2026q3-v1) ## Video: Choosing to Wait: A New Approach to Treating Breast Cancer at Its Earliest Stages [Watch (HLS stream): Choosing to Wait: A New Approach to Treating Breast Cancer at Its Earliest Stages](https://cdn.jwplayer.com/manifests/qPQnIqEX.m3u8) (5:56)  _Published 2015-10-01. Colletti, 60, was diagnosed with ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer, in April 2014. But rather than immediately having surgery, Colletti opted for a new form of alternative treatment: active surveillance._ by [Siobhan O'Connor](https://time.com/author/siobhan-oconnor/) and [Diane Tsai](https://time.com/author/diane-tsai/) Oct 1, 2015 2:58 PM UTC by [Siobhan O'Connor](https://time.com/author/siobhan-oconnor/) and [Diane Tsai](https://time.com/author/diane-tsai/) Oct 1, 2015 2:58 PM UTC _This video is a companion to the TIME cover story:_ [_Why Doctors Are Rethinking Breast Cancer_](http://time.com/4057310/breast-cancer-overtreatment/)_._ “My daughter’s initial reaction was, ‘Mom, if it was me, I’d take it out,'” Laura Colletti, 60, recalls. Colletti was diagnosed with ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer, in April 2014\. But rather than immediately having surgery, Colletti opted for an alternative—something called active surveillance. Thanks to advances in genomic testing and deeper insights into the biology of different kinds of breast cancer, doctors are learning that the one-size-fits-all approach isn’t working. They’re also learning that every woman brings with her a unique profile of biological risk—as well as a unique appetite _for_ risk. That means that while some women require urgent and aggressive treatment, there are many who can slow down and take a more sparing approach. Colletti was referred to Dr. Shelley Hwang, chief of breast surgery at Duke Medical Center in North Carolina, who is one of the growing number of breast cancer experts in the U.S. who partner with patients on active surveillance for patients with low-grade DCIS. With this watch-and-wait approach, patients forgo traditional treatments like radiation and surgery and instead do screenings—mammograms, MRIa—every six months, sometimes in tandem with hormone therapy. This represents a paradigm shift in breast cancer treatment, with a small but influential chorus of experts calling for a major shift in the way doctors treat—and talk about—the disease, from the first few millimeters of suspicious-­looking cells in milk ducts to the invasive masses found outside of them. That’s making the tough conversations between a woman and her cancer doctor ever harder, but it also stands to make them more fruitful. Because as good as we have gotten at finding breast ­cancer—and we’ve gotten very good—new data suggests there may be better ways to treat some breast cancers, particularly those at the early stages. Evidence is mounting that aggressive treatments, designed in earnest to save women’s lives, can have unforeseen and sometimes devastating consequences. It’s the multiple follow-up surgeries after a mastectomy and the subsequent infections; the radiation that doesn’t always improve survival and the cancer risk that can come with too much of it; the sometimes unnecessary chemo­therapy and its life-­sapping side effects. For some in the field, that collateral damage is getting harder and harder to justify. [_Read more: Click here for TIME’s cover story about why doctors are rethinking breast cancer treatment_](http://time.com/4057310/why-doctors-are-rethinking-breast-cancer-treatment). ## Transcript [ MUSIC ] One of the best things about my job is that I see patients who have a potentially lethal diagnosis and I'm able to be part of what allows them to be cured of their disease. The flip side is that one of the least rewarding experiences I have Of. And when I see a patient who is so fearful and so not at peace with her own body that she feels that she has to do extraordinary things to be free of her anxiety of breast cancer. [ MUSIC ] My daughter's initial reaction was, [ MUSIC ] Mom, if it was me I'd take it out. You just get rid of it. My husband and I did a ton of research, and we reviewed studies, and all the information out there, and decided that really we don't have to have surgery. That it's not life- threatening, and I'll probably die from something else. [ MUSIC ] [ BLANK_AUDIO ] So if you would If you felt a nodule or [ INAUDIBLE ] I'm fortunate to be on the early side of things where most of the patients I see have very early, very treatable problems and I think that's how I got interested in DCIS, because of all the so- called cancers that we diagnose now, DCIS is the very earliest form. [ MUSIC ] Active surveillance is very new. And for many people, both on the physician's side and the patient's side, it's a scary proposition. I'm certainly not condoning it for everyone. I'm not recommending that everyone with DCIS follow a path of active surveillance. But I think it should be considered in the context of all the options that patients have. All of us have different comfort levels of how far we're willing to go to be sure we don't die of this and that other disease. But we all die of something. And we can't prevent everything. [ MUSIC ] So in April of 2014 I was diagnosed with DCIS. When they gave me the diagnosis I initially felt a lot of dread, got sick to my stomach and just thought oh no so what is this going to lead to. My daughter's initial reaction was, mom, if it was me, I'd take it out. And that was initially how she felt until we discussed it. And when we talked about the risks of surgery and radiation treatments, and some of the things that can happen with that, and the fact that these are pre- cancerous cells that may just sit there and never do anything. She came around. So, DCIS stands for ductal carcinoma in situ. And the in situ part is that the cells, the abnormal cells are contained within the ducts of the breast Once the cells break out of the ducts its called an invasive cancer, and those are the cancers that can spread to the lymph nodes and can spread to other parts of the body and eventually cause mortality. [ SOUND ] There have been a couple of very important studies that have been published lately which have shown that for the very low risk DCIS Whether you ever operate on them, whether you do a lumpectomy or whether you do a mastectomy, the patients are equally likely to not die of breast cancer. So removing both your breasts at that phase really doesn't help a woman to live longer. And I feel that for some of those patients They see mastectomy as being a way to rid themselves of anxiety. And that makes me sad. I think there are much better ways to reduce anxiety than to do a pretty major operation after which you're never really going to be the same. And the side effects that patients have in terms of discomfort with themselves. Never feeling like they're whole again. A lot of the work that I do in clinic is being with patients at probably one of the most vulnerable and scary times of their lives. And to be part of that process and to see patients through that is incredibly rewarding. The initial fear that you have I think is just because you don't know what's going to happen, but you know if you read the studies And you look at the information out there, I don't feel afraid at all. I feel great about my decision. If options were given to women, more women would choose active surveillance, but because there's no options out there, people don't know to even ask. Ask. 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