Dr. Esserman, 58, is one of the most vocal proponents of the idea that breast cancer screening brings with it overdiagnosis and overtreatment. Her philosophy is controversial, to say the least. For decades, the specter of women dying for lack of intervention has made aggressive treatment a given.
But last month, her approach was given a boost by a long-term study published in the journal JAMA Oncology. The analysis of 20 years of patient data made the case for a less aggressive approach to treating a condition known as ductal carcinoma in situ, or D.C.I.S., for which the current practice is nearly always surgery, and often radiation. The results suggest that the form of treatment may make no difference in outcomes.
Dr. Esserman, who directs the Carol Franc Buck Breast Care Center, is one of only a few surgeons in the United States willing to put women with D.C.I.S. on active surveillance instead of performing biopsies, lumpectomies or mastectomies. She and other critics of vigorous intervention point to the potential side effects and risks of sometimes disfiguring treatments for premalignant conditions that are unlikely to develop into life-threatening cancers.
Dr. Esserman received national attention five years ago with an innovative, adaptively randomized drug trial called I-SPY 2, aimed at reducing the cost and time required to test new medications for breast cancer. The trial matches drugs with patient subtypes, allowing drugs from different companies to be assessed simultaneously, and much earlier in the disease process, while quickly phasing out those that do not appear to be working.
Trials for drugs to treat other cancers, as well as Alzheimer’s disease and Ebola, have adopted the design, said Donald Berry, a statistician at M.D. Anderson in Houston who designed I-SPY 2 with Dr. Esserman.
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