Surgery to Remove Cancer and Adequate Amount of Surrounding Tissue

Surgery to Remove Cancer and Adequate Amount of Surrounding Tissue May Eliminate Need for Radiation Therapy

Ductal Carcinoma In Situ: Surgery to Remove Cancer and Adequate Amount of Surrounding Tissue May Eliminate Need for Radiation Therapy

Women who have ductal carcinoma in situ, an early form of breast cancer, are often treated with surgery followed by radiation therapy. In 1 recent report, researchers from California indicate that if enough of the normal breast tissue surrounding the cancer is removed during the surgery, subsequent radiation therapy may not be needed.

Breast cancer is characterized by the presence of cancer cells in the tissue or ducts of the breast. Depending on the

stage of disease (extent of the cancer at diagnosis), treatment options may include surgery, chemotherapy, radiation therapy, and/or hormone therapy.

Ductal carcinoma in situ (DCIS) is a very early cancer, referred to as stage 0 breast cancer, that occurs in a duct of the breast. DCIS is commonly treated with surgery to remove the cancer and some of the surrounding normal tissue (

lumpectomy or

partial mastectomy) or surgery to remove the whole breast (

total mastectomy). The width between the edge of the cancer and the outside edge of the normal tissue that is removed is called the

surgical margin. After surgery, radiation therapy to the breast area and/or hormone therapy may also be given to help prevent a

local recurrence of the disease (return of cancer in the breast). To ensure that the most effective treatments are provided and unnecessary treatments are avoided, researchers continue to study the use of different surgical techniques, with and without radiation therapy, for DCIS.

Researchers in California evaluated the treatment outcomes for 469 women with DCIS who underwent surgery. Some of the women underwent radiation therapy after surgery, while others did not. The findings showed that, after 8 years, patients for whom surgery resulted in surgical margins of 10 mm or more had a 4% local recurrence rate, and any radiation therapy had no effect. For those with surgical margins of 1 to 10 mm, radiation therapy also produced no effect. However, patients with surgical margins of less than 1 mm benefited from radiation therapy, with those who underwent radiation therapy having a lower local recurrence rate than those who did not.

The researchers concluded that surgery that produces adequate surgical margins is an effective treatment approach for women with DCIS, making radiation therapy unnecessary. Some women may, however, benefit from hormone therapy after the surgery. Women who have been diagnosed with DCIS may wish to discuss with their doctor the risks and benefits of the various treatment options currently available, including the different surgical approaches and possible followup radiation therapy and/or hormone therapy. (

New England Journal of Medicine, Vol 340, No 19, pp 1455-1461, 1999)

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