According to an early online publication of the Journal of Clinical Oncology, treating patients with ductal carcinoma in-situ (DCIS) of the breast with wide excision alone results in a substantial amount of local recurrences. Additional treatment with radiation and/or hormone therapy for these women may help to reduce these recurrences.
Ductal carcinoma in situ (DCIS) is the earliest possible clinical diagnosis of breast cancer. It is frequently diagnosed with screening mammography that has detected small areas of calcification in the breast. Patients rarely suspect that they have breast cancer with this stage of cancer.
Researchers have focused on determining optimal treatment of DCIS; optimal treatment would provide the lowest rates of recurrence and development of invasive breast cancer and result in the fewest side effects. A question of great interest is whether surgery with wide excision alone is sufficient treatment for DCIS, or whether surgery should be combined with radiation therapy.
Wide excision refers to the surgical removal of the cancer as well as a substantial margin of healthy tissue. Previous studies have indicated that the addition of radiation therapy to wide excision does improve outcomes for patients with DCIS.
Researchers from several institutions recently conducted a clinical study to evaluate the rates of recurrences among women with DCIS who were treated with wide excision alone. This study included 158 patients who were treated with wide excision consisting of removal of at least 1 centimeter of healthy tissues surrounding the cancer. Median follow-up was 40 months.
- At 5 years, 12% of patients experienced a recurrence.
- Among those who experienced a recurrence, 69% of patients experienced a recurrence of DCIS, and 31% of patients experienced a recurrence that had spread into the breast.
- Most of the recurrences occurred within the same quadrant of the breast as the original DCIS.
- No patient experienced a spread of cancer to the axillary (under the arm) lymph nodes.
- No patient experienced a spread of cancer to distant sites in the body.
The researchers concluded that wide excision alone results in an approximate 12% recurrence rate in patients with DCIS. Although there were no instances of distant spread, the researchers suggested that these results indicate that the addition of radiation therapy or hormone therapy in eligible patients may help reduce these local recurrences.
Reference: Wong J, Kaelin C, Troyan S, et al. Prospective Study of Wide Excision Alone for Ductal Carcinoma in Situ of the Breast. Journal of Clinical Oncology. 2006. Early online publication. DOI: 10.1200/JCO.2005.02.9975.
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