Jun 05, 2026
In April 2026, a Dutch randomized trial reported that women with low-risk “Stage 0 breast cancer” who skipped surgery did no worse than women who had it. I have been making this argument since 2008. Here is the evidence — including the one statistic that quietly dismantles the case for cutting.
Four decades of screening generated an archive of diagnoses — and, the evidence now suggests, more than two million overdiagnoses.
In April 2026, at the European Breast Cancer Conference in Barcelona, Jelle Wesseling of the Netherlands Cancer Institute stood up and said, in the careful language of a man who knows exactly how much weight his words carry, that the early results were “reassuring.”
He was presenting the LORD trial — 1,423 women with low-risk ductal carcinoma in situ, the diagnosis the medical system calls “Stage 0 breast cancer.” Some had immediate surgery. Most chose active surveillance: regular imaging, and surgery only if something changed. After about two years, the women who were simply watched developed invasive cancer at a rate of roughly 6% — lower than the 9% rate in the women who went straight to the operating table.(1)
“For decades,” Wesseling said, “DCIS was framed as ‘early-stage breast cancer.’ As a result, it has almost always been treated in the same way as breast cancer. But if most DCIS will never become dangerous, an important question arises: are some women receiving more treatment than they need?”(1)
I have been asking that exact question in print since 2008, the year I first put my research online with the founding of GreenMedInfo.com. This is not a victory lap. It is something more important: a moment to lay out, in full, the evidence that the most common “cancer” diagnosis surge of the mammography era may have been, in a large fraction of cases, not cancer at all — and to confront the single objection that the entire surgical paradigm rests on, an objection that turns out to be, on close inspection, partly an illusion of arithmetic.
And to count the cost. Because if the science is only now catching up, then the bill for the delay has been paid — is still being paid, this year — by women. Below, I put a number on it.
I. A Twenty-Year Position, Briefly Stated
Since GreenMedInfo’s inception in 2008, I have argued that ductal carcinoma in situ — abnormal cells confined within the milk duct, by definition not invasive, by definition not spread — was misclassified the moment the word “carcinoma” was attached to it.
The dated record:
2011–2012: I wrote that DCIS was “a form of breast cancer that a growing body of research indicates may not be cancer at all,” and that the lifetime risk of a given DCIS lesion progressing to invasive disease was “perhaps as low as 2–4%.”(2) The 10-year survival of treated DCIS — 96% to 98% — said everything about how non-lethal the underlying condition was.
2012: Building on Bleyer and Welch’s landmark analysis in the New England Journal of Medicine — published 14 years ago next month — I documented that three decades of mammographic screening had generated an estimated 1.3 million American women overdiagnosed and overtreated for breast cancer, many of them for DCIS. That paper is now old enough to drive. The overdiagnosis it described did not stop in 2012; it has compounded every year since. (See Section II-B below for what the number looks like today.)(3)
2024: When the COMET trial reported that active monitoring produced no greater two-year risk of invasive cancer than surgery, I wrote that it “marks a pivotal moment in redefining DCIS.”(4) (See: Reclassifying DCIS: A Groundbreaking Shift in Breast Cancer Diagnosis After Over a Decade of Advocacy.)
2025–2026: I situated DCIS at the center of the larger mammography overdiagnosis crisis. (See: The Mammography Deception: Why RFK Jr. Is Right for the Wrong Reasons and “We Gave Chemotherapy to 90 Women to Benefit 10.”)
LORD, in 2026, is the second randomized controlled trial — after COMET — to validate the direction of that twenty-year argument. The position is no longer fringe. It is being tested in the most rigorous instrument medicine possesses, and it is holding.
II. What DCIS Actually Is
DCIS by definition: abnormal cells confined within the duct, the basement membrane intact and unbreached. “In situ” means in its original place — not invasive, not spread.
Ductal carcinoma in situ describes a proliferation of abnormal cells within a milk duct. The cells have not crossed the basement membrane. They have not invaded surrounding tissue. They have not spread. In situ means, literally, “in its original place.”
Before mammography, DCIS was almost unknown — it produces no lump, no symptom, no sign. It became visible only when high-resolution X-ray screening began finding microcalcifications in the 1980s. Today it accounts for roughly 20% of all breast cancer diagnoses, more than 50,000 women a year in the United States.(5) A condition that was clinically invisible for the entire history of medicine is now the fourth most common cancer diagnosis in American women — not because women’s bodies changed, but because the detection technology did.
And a 2025 Dutch micro-simulation study published in The Breast put a number on the consequence: in biennial screening, about 1 in 5 DCIS diagnoses is overdiagnosed — detected in a woman who would never have suffered from it. Notably, that overdiagnosis rate was nearly the same across all grades — 24% for grade 1, 20% for grade 2, 18% for grade 3 — and because, as the authors note, “DCIS is always treated when diagnosed,” every one of those overdiagnoses becomes an overtreatment.(6)
II-B. The Fourteen-Year Bill: How Many Women, By This Year?
In November 2012, Bleyer and Welch wrote a sentence in the New England Journal of Medicine that should have changed American medicine. They estimated that over three decades of screening mammography — 1982 to 2011 — breast cancer had been overdiagnosed in 1.3 million U.S. women. In 2008 alone, they wrote, it was overdiagnosed in more than 70,000 women — 31% of all breast cancers diagnosed that year. And of the 122 additional early-stage cancers detected per 100,000 women by screening, only 8 were expected to ever progress to advanced disease.(3)
That paper is now fourteen years old. The screening did not stop. The overdiagnosis did not stop. So the honest question — the one a reader recently put to me — is: if it was 1.3 million women then, what is it now?
Let me show the arithmetic in the open, because a number this large should never be asserted without its scaffolding.
The all-breast-cancer figure. Bleyer and Welch’s 1.3 million covered 1982–2011. From 2012 through this year, 2026, is fifteen more years. If we simply hold the rate at the 2008 steady-state of ~70,000 overdiagnoses a year — assuming, charitably, no growth at all despite rising diagnosis counts — that adds roughly 1.05 million more women. The cumulative total of American women overdiagnosed with breast cancer since screening began now stands at approximately 2.35 million. Hold it instead at a deliberately conservative 60,000/year and the total is still about 2.2 million. Either way: we have crossed two million.
The DCIS-specific figure. Narrow to “Stage 0” alone. The American Cancer Society projects 60,730 new DCIS diagnoses in 2026 — up from 56,500 in 2024 and 59,080 in 2025.(5) Summing the annual DCIS counts from 2012 through 2026 yields roughly 810,000 women diagnosed with DCIS in those fifteen years. Apply Poelhekken’s overdiagnosis rate of about 1 in 5 — and recall that, because DCIS is always treated when found, every overdiagnosis is an overtreatment — and you get an estimated 160,000 to 200,000 American women subjected to surgery, radiation, and/or anti-estrogen therapy in the last fifteen years for a “cancer” that would never have harmed them.(6) At the current rate, that is on the order of 12,000 women every single year — this year — losing breast tissue, enduring radiation, or taking tamoxifen for a lesion their own bodies would have contained.
These are estimates, and I label them as such. They rest on published incidence counts and published overdiagnosis fractions, and they make conservative assumptions at every turn. The precise figure is unknowable; the order of magnitude is not. The cost of the fourteen-year delay between the evidence and the practice is measured in the hundreds of thousands of women.
And here is the finding that should haunt every defender of the status quo. In September 2025, researchers at the American Cancer Society itself — Hyuna Sung, Ahmedin Jemal, and colleagues — published the first long-term analysis of DCIS death rates in Breast Cancer Research. Their conclusion: “the death rate from DCIS in the United States has not decreased from 2000 to 2021.“ Twenty-one years. Hundreds of thousands of surgeries and radiation courses. And the death rate did not move. The authors state it plainly: “advancements in DCIS treatment have not been sufficient to reduce mortality,” and “evidence [is] lacking demonstrating its impact on reducing breast cancer-specific mortality.”(11) We have been treating harder, not living longer.
III. The Objection That Holds Up the Entire Surgical Paradigm
Here is the strongest argument against my position, and I want to state it as fairly as its proponents would.
The observational data appear to show that surgery works. A 2024 systematic review and meta-analysis of nearly 48,000 women found that the 10-year rate of invasive cancer in the same breast was 6.4% in women who had surgery versus 22.7% in women who did not.(7) On its face, that looks devastating: surgery cuts invasive recurrence by more than two-thirds. Case closed.
Except — look closely at what is being counted. The endpoint is “invasive ipsilateral breast tumor event“: invasive cancer detected in the same breast.
Now ask the obvious question. If you have removed the breast tissue — the duct system in a lumpectomy, the entire organ in a mastectomy — where, exactly, is the “ipsilateral recurrence” supposed to appear?
You cannot detect cancer in tissue that is no longer in the body. A meaningful portion of that headline “reduction” is not a biological triumph over disease. It is arithmetic. It is the mechanical consequence of having removed the place where the event was defined to occur. The surgery doesn’t just treat the disease; it deletes the denominator. You have not necessarily made the woman safer — you have made the recurrence unmeasurable.
This is the missing-tissue artifact, and once you see it, you cannot unsee it. The observational literature that “proves” surgery works is, in large part, measuring its own definition.
The missing-tissue artifact: a recurrence can only be counted where the tissue still exists. Remove the breast, and you do not necessarily remove the danger — you remove the place we look for it.
IV. The One Number That Survives the Artifact
There is, however, an endpoint that the missing-tissue artifact cannot touch: death.
A woman can die of metastatic breast cancer whether or not her breast was removed. Mortality doesn’t care where the tissue is. So if surgery and radiation genuinely defeat the danger of DCIS — rather than merely erasing the place we look for it — then more aggressive local treatment should produce lower mortality.
In 2015, Steven Narod and colleagues tested exactly this, using the SEER database — 108,196 women followed for up to 20 years. The findings should have ended the debate:(8)
Twenty-year breast-cancer mortality after a DCIS diagnosis was 3.3% — already extraordinarily low, in the range of the background population.
Radiotherapy after lumpectomy cut the rate of invasive in-breast recurrence nearly in half (4.9% to 2.5%) — and yet had no measurable effect on breast-cancer mortality whatsoever (0.9% vs 0.8%; hazard ratio 0.86, not statistically significant).
Most damning of all: 517 women died of breast cancer without ever having an invasive recurrence in the breast first.
Sit with that last finding. More than five hundred women whose lethal disease appeared despite — or entirely apart from — any local recurrence. Their cancer was already systemic, already capable of killing, at the moment of the DCIS diagnosis. No mastectomy could have removed what had already left the breast. And conversely: preventing local recurrence, the thing surgery and radiation are so good at, did not save lives.
If cutting out the breast removed the danger, treating the breast more aggressively would lower mortality. It does not. That single fact — artifact-proof, drawn from the largest dataset we have — is the quiet demolition of the claim that DCIS surgery is saving large numbers of lives. It is preventing a recurrence statistic. It is not, for the overwhelming majority of women, preventing a death.
And it does not stand alone. The 2025 American Cancer Society mortality-trend analysis is the population-level confirmation of Narod’s patient-level finding: across an entire nation, across two decades, as treatment intensified, DCIS death rates held flat.(11) Two independent lines of evidence — one from the largest patient cohort, one from the longest national trend — converge on the same artifact-proof conclusion. The breast was removed. The radiation was delivered. Death did not retreat.
V. The Honest Caveat — Because This Argument Has to Be Bulletproof
I am not going to overstate this, because the strongest version of an argument is the one that has already absorbed its best counter.
There is one thing surgery does that watchful waiting cannot: it sometimes finds occult invasive cancer that was already present but missed on the needle biopsy. In COMET, roughly 14% of women sent to surgery turned out to harbor invasive disease; in LORD, 29 of 363 surgical patients had invasive cancer detected at the start.(1,9) A computational model by Ryser found that the single most important variable determining whether active surveillance is safe is precisely this “probability of understaging.”(10)
But notice: this is a detection benefit, not a tissue-removal artifact, and it argues for better biopsy and better imaging and careful patient selection — not for the reflexive removal of breasts from 50,000 women a year. It tells us which women need intervention. It does not justify treating an entire category of finding as if it were lethal.
This is why the defensible claim is precise: low-risk DCIS is frequently indolent, systematically over-treated, and — for carefully selected women — safely managed by active surveillance. That is now supported by two randomized trials and the largest mortality dataset in existence. It is no longer a contrarian opinion. It is, increasingly, where the evidence points.
VI. Why This Tragedy Keeps Happening
If the evidence has pointed this way for years, why does a woman still walk out of a clinic this week, this year, with a breast scheduled for removal over a lesion that may never have hurt her? The answer is not a single villain. It is a system with four interlocking failures, and I have spent two decades documenting each one.
First, the naming error. The deepest mistake in the DCIS story was never surgical. It was linguistic. The word “carcinoma” turned a tissue-level finding into a death sentence in the patient’s mind, and the system responded to the word, not the biology. In situ means “in its original place” — contained, not invasive, not spread. But you cannot hear the word “carcinoma” across an exam table and weigh probabilities. You hear cancer, and you consent to almost anything. Women lost breasts to a noun. A growing chorus of clinicians now argues openly that we should “take carcinoma out of DCIS” and stop calling it cancer at all — the precise reclassification I called for more than a decade ago.
Second, the financial cascade. A diagnosis is the entry point to a revenue pipeline: the biopsy, the surgery, the radiation suite, the pathology, the anti-estrogen prescription, the years of follow-up imaging. An entire ecosystem is funded by finding more, not by finding less. As I wrote years ago, the apparatus is capable of “driving billions of dollars of revenue by producing more of what it claims to be fighting.” Nobody bills for reassurance. There is no procedure code for “we watched, and nothing happened.” The incentives run in exactly one direction, and it is not toward restraint.
Third — and this is the part that reaches past breast cancer into the whole of modern medicine — the doctrine of genetic determinism. We were taught that our DNA is destiny, that a “cancer gene” is a loaded fate, and that the rational response to risk is to cut. This is the logic that put a scalpel in the hand and a target on healthy tissue. But it is biologically wrong. As I argue in my forthcoming book Regenerate, the old gene-disease narrative has been supplanted by epigenetics — the science of the factors above the genes that determine which are switched on and which are silenced. Diet, toxic exposures, inflammation, the microbiome, stress, sleep, the “exposome” of our cumulative lifetime insults: these, far more than any inherited sequence, govern whether disease is expressed. Genes load the gun, but environment pulls the trigger.
Nowhere is the determinist error more visible than in the mythology around BRCA1 and BRCA2. We have been sold the idea that these genes are “harbingers of inevitable breast cancer” — the logic that led to prophylactic removal of healthy breasts and ovaries. Yet the medical literature is deeply equivocal: some BRCA polymorphisms are inversely related to breast cancer risk, and women with BRCA mutations who develop breast cancer often have higher survival than those without. The terrain — nutrition, chemical exposure, emotional state — can switch the cancer-protective function of these genes on or off regardless of which version you inherited. To surgically remove organs to prevent lesions from forming, I have written, “makes just about as much sense as decapitation to prevent a headache.” It is the quick-fix, symptom-suppressive reflex of a paradigm with tunnel vision on the tumor — one that misses the forest for the trees and never asks what gave rise to the cancer in the first place.
Fourth, the manufactured fear that makes patients complicit in their own overtreatment. Cancer-phobia, stoked by pink-ribbon marketing and the language of “early detection saves lives,” pours gasoline on the flames. A frightened patient does not negotiate. And here is the cruel biology of it: that very fear produces a flood of stress hormones that, as the research shows, can itself magnify risk — a vicious cycle in which the dread of the disease becomes a driver of it.
Four failures, one outcome: a containment process the body was managing gets reclassified as a catastrophe, monetized as a pipeline, justified by a discredited theory of inevitability, and sold to a terrified patient. The COMET and LORD trials are now dismantling that machinery with randomization and institutional caution — doing, at last, what the evidence supported when I first wrote about it.
VII. The Toll We Do Not Count
The toll begins the moment the word is spoken. Studies find the psychological wound of a breast-cancer diagnosis persists for years — even when the lesion was never a threat.
When we tally the cost of overtreatment, we count surgeries and dollars. We rarely count what the diagnosis itself does to a woman — and that omission is its own injustice.
The psychological wound arrives the instant the word is spoken, and it does not heal cleanly even when the lesion is benign. A study in the Annals of Family Medicine found that women given a false-positive breast cancer diagnosis still reported greater harm across all twelve measured psychosocial domains — dejection, anxiety, sleep, sexuality, sense of attractiveness, inner calm, existential values — fully three years after being declared cancer-free. Six months after the all-clear, their losses of “inner calmness and existential values” were “as great as those reported by women with a diagnosis of breast cancer.” Being cleared left scars equivalent to having had the disease. And the cumulative probability of a false-positive recall or biopsy recommendation after a decade of screening is at least 50%.(12) The risk of suicide in the week after a cancer diagnosis has been measured at up to 16 times higher, and cardiac death up to 26.9 times higher, than after an all-clear.(12) Fear, it turns out, is not metaphorically lethal. It is measurably so.
The biological toll is just as real, and crueler still, because some of it is inflicted by the treatment meant to help. Mammography’s low-energy X-rays are, by radiobiological measure, roughly four to six times more effective at causing mutational damage than the high-energy radiation our risk estimates are based on — meaning the very screening that finds DCIS carries an under-counted potential to cause breast cancer.(12) And the treatments themselves are not benign: research from the UCLA Jonsson Comprehensive Cancer Center found that radiation, even while killing half a tumor’s cells, can leave the survivors — induced breast cancer stem cells — up to 30 times more likely to form new tumors. The therapy shrinks the visible mass, creating the appearance of success, while enriching the population of the most malignant cells.(12) We have, in too many cases, frightened healthy women, irradiated them, and called it care.
This is the human ledger behind the statistics in Section II-B. Behind every number is a woman who carried anxiety for years, or lost a breast she did not need to lose, or was exposed to radiation and cellular harm in the name of a “cancer” that was never going to take her life. That is the tragedy — not an abstraction, but a toll paid in sleep, in intimacy, in inner calm, and sometimes in life itself.
The science is catching up. It took twenty years. The women treated in the interval — the two-million-plus overdiagnosed, the hundreds of thousands overtreated for “Stage 0” alone — deserve to know that the question was being asked all along, and that the answer was, increasingly, on their side.
Dive Deeper
For more information on breast cancer, consult the GreenMedInfo.com database on the subject, and consult my book REGENERATE, whose most comprehensive chapter are on the topic on both the causes and natural and integrative approaches to both diagnosis and treatment.
References
[1] ASCO Post. “Early Results From a Trial of Active Surveillance for Low-Risk DCIS Are ‘Reassuring,’ Say Researchers.” April 1, 2026. LORD trial (NCT02492607), presented at EBCC15, Barcelona, by J. Wesseling. https://ascopost.com/news/april-2026/early-results-from-a-trial-of-active-surveillance-for-low-risk-dcis-are-reassuring-say-researchers/
[2] Ji, S. “Mammograms Linked To An Epidemic of Misdiagnosed Cancers.” GreenMedInfo, 2012. https://greenmedinfo.com/blog/mammograms-linked-epidemic-misdiagnosed-cancers — “Breast Screenings Creating An Epidemic of Over-Diagnosis.” GreenMedInfo, Feb 27, 2012. https://greenmedinfo.com/blog/breast-screenings-creating-epidemic-over-diagnosis
[3] Ji, S. “30 Years of Breast Screening: 1.3 Million Wrongly Treated.” GreenMedInfo, 2012. https://greenmedinfo.com/blog/30-years-breast-screening-13-million-wrongly-treated — Bleyer A, Welch HG. “Effect of three decades of screening mammography on breast-cancer incidence.” N Engl J Med. 2012;367(21):1998–2005.
[4] Hwang ES, et al. “Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ: The COMET Randomized Clinical Trial.” JAMA. 2025;333(11):972–980. PMID 39665585. https://pubmed.ncbi.nlm.nih.gov/39665585/
[5] American Cancer Society, Breast Cancer Facts & Figures (DCIS ≈ 20% of new breast cancer diagnoses).
[6] Poelhekken K, et al. “Overdiagnosis of ductal carcinoma in situ by grade and definition in population-based screening: A modeling study.” The Breast. 2025. PMID 41082841. https://pmc.ncbi.nlm.nih.gov/articles/PMC12547802/
[7] Chen Q, Campbell I, Elwood M. “Outcomes from low-risk ductal carcinoma in situ: a systematic review and meta-analysis.” Breast Cancer Res Treat. 2024. PMID 39180592. https://pubmed.ncbi.nlm.nih.gov/39180592/
[8] Narod SA, Iqbal J, Giannakeas V, et al. “Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ.” JAMA Oncol. 2015;1(7):888–896. PMID 26291673. https://pubmed.ncbi.nlm.nih.gov/26291673/
[9] Surgical upstaging literature: PMIDs 28700803, 34091677, 28795370, 35278202.
[10] Ryser MD, et al. “Outcomes of Active Surveillance for Ductal Carcinoma in Situ: A Computational Risk Analysis.” J Natl Cancer Inst. 2016. PMID 26683405. https://pubmed.ncbi.nlm.nih.gov/26683405/
[11] Sung H, Jiang C, Jatoi I, Jemal A. “Trends in breast cancer death rates from ductal carcinoma in situ in the United States.” Breast Cancer Res. 2025 Sep 26;27:164. doi:10.1186/s13058-025-02068-9. PMID 41013593. https://pmc.ncbi.nlm.nih.gov/articles/PMC12465744/ — death rate from DCIS “has not decreased from 2000 to 2021.”
[12] Ji, S. “’Hidden Dangers’ of Mammograms Every Woman Should Know About.” GreenMedInfo. https://greenmedinfo.com/blog/hidden-dangers-mammograms-every-woman-should-know-about — synthesizing: Brodersen J, Siersma VD. “Long-term psychosocial consequences of false-positive screening mammography.” Ann Fam Med. 2013;11(2):106–15 (PMID 23508596); Hubbard RA, et al. “Cumulative probability of false-positive recall after 10 years of screening mammography.” Ann Intern Med. 2011;155(8):481–92 (PMID 22007042); and UCLA Jonsson Cancer Center radiation-induced breast cancer stem cell findings (Cancer, 2012).
[13] Ji, S. Regenerate: Unlocking Your Body’s Radical Resilience through the New Biology — on epigenetics, the exposome, BRCA mythology, and “genes load the gun, but environment pulls the trigger.”
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