I appreciated Mikkael A. Sekeres’s Oct. 12 online column, “I’m an oncologist. Here’s what to know about DCIS or Stage 0 breast cancer,” about whether to remove the word “cancer” from a ductal carcinoma in situ (DCIS) diagnosis. I’m a DCIS patient, and I have been living under active surveillance for more than two years. I know firsthand how powerfully the word “cancer” can shape treatment decisions.
But changing the terminology addresses only part of the problem. Fear also comes from being presented with the choices of surgery, radiation and hormone therapy for a condition that may never become invasive. Patients need clear explanations of their individual risks and alternative treatment choices that are grounded in evidence.
Active surveillance clinical trials offer reason for hope, especially the COMET trial. Its early results, published in JAMA, found that after two years of active surveillance, the rate of invasive cancer among women with low-risk DCIS was no higher than among those who received standard care, including surgery and radiation. Surveillance involved regular imaging and examinations; some participants also took hormone therapy.
Additional follow-up is still needed to establish long-term safety, and active surveillance will not be appropriate for everyone. But these findings underscore the importance of prioritizing research into less-invasive approaches and identifying who can safely benefit from them.
I am already following this path with my physician, and I want more women to have the opportunity to consider it when appropriate for their individual diagnosis. Whatever we call DCIS, women deserve the information, time and treatment choices needed to make decisions based on their actual risks, priorities and values.
Julia Stalder, Cold Spring, New York
The writer is the founder of the nonprofit DCIS Understood.
E-bikes and scooters make D.C. less safe
Regarding the Oct. 13 Metro article “D.C. city official killed in electric scooter collision”:
The unfortunate loss of Talib Shakir in an electric scooter collision on Oct. 9 puts a spotlight on how dangerous these vehicles can be.
Yes, they provide a viable, affordable alternative to cars, but they are unsafe to pedestrians. There are too many riders who disregard traffic laws and ride on sidewalks, oftentimes right next to a protected bike lane in the street. And the vehicles are so quiet that pedestrians can be taken by surprise as they whiz by. I experience close calls both as a driver and as a pedestrian almost daily.
Something must be done to make our streets safer. D.C. could hire more traffic cops who focus just on e-bike and scooter safety, require helmets, and get rid of the contraflow bike lanes that allow bicycles to ride in the opposite direction of cars on one-way streets. Whoever thought of that is probably not a pedestrian. Who thinks to look both ways on a one-way street?
Nan Raphael, Washington
Americans deserve peptide scrutiny
Regarding the Oct. 9 news article “Temporary sale of some unapproved peptides planned”:
Allowing the sale of certain unapproved peptides could expose patients to harm before basic questions about safety, dosing and product quality have been answered. Public demand and commercial interest must not get ahead of science.
The Food and Drug Administration has already flagged risks involving peptide-related impurities and adverse reactions, along with gaps in safety information for several peptides. Enhanced disclosures and serious adverse event reporting are not sufficient replacements for rigorous clinical trials.
In my work as a compounding pharmacist, I’ve seen the legitimate role compounded products can play in treating patients whose individual medical needs cannot be met by approved medicines. Americans deserve confidence that the medicines they receive are backed by science and safety standards. Peptide sales should not be expanded before that work is done.
Fred H. Mills Jr., St. Martinville, Louisiana
The writer, a former executive director of the Louisiana Board of Pharmacy, is chief policy officer of Americans for Safe and Effective Medicines.
The real Winnie
Regarding the Oct. 14 online news article “In which Winnie-the-Pooh turns 100 and Britain wants its bear back”:
Oh, bother. While the transatlantic diplomatic tussle over the beloved stuffed toy rages, it might be worth pointing out that neither New York nor London really can claim ownership of the iconic bear that inspired the story.
The real, bona fide Winnie was a black bear named for the city of Winnipeg who traveled to Britain with a Canadian soldier when he was sent to train there at the start of World War I. While the soldier was fighting in France, the bear lodged at the London Zoo, and that is where a young Christopher Robin first encountered it. Christopher quickly changed the name of his stuffed toy bear, which was purchased at Harrods, to, of course, Winnie.
Kevin Tibbles, Highland Park, Illinois
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