Excision
Alone May Not be Optimal for Ductal Carcinoma in Situ of the
Breast
According to results presented at the 2003 San Antonio Breast
Cancer Symposium, wide excision alone may not be the optimal
treatment strategy for ductal carcinoma in situ of the breast.
Ductal carcinoma in situ (DCIS) of the breast is a condition
involving abnormal cells in the ducts of the breast that are
slower growing than normal breast cancer cells, but have the
potential to develop into invasive breast cancer. DCIS is
different than invasive breast cancer in that it tends to
have a slow rate of spread, and the development of breast
cancer from DCIS may be years or even a couple of decades.
However, DCIS is treated in order to prevent the development
of invasive breast cancer. Patients are usually treated with
the surgical removal of DCIS with or without radiation therapy.
The incidence of DCIS is increasing, which is thought to at
least be partially due to earlier detection by mammography.
Thus, researchers have been focusing efforts on optimal treatment
of DCIS, in an attempt to provide the lowest rates of recurrence
or development of invasive breast cancer, coupled with treatment
resulting in the fewest side effects.
Researchers from the Dana Farber/Harvard Medical Center recently
conducted a clinical study to evaluate the effectiveness of
wide excision alone in the treatment of DCIS. Wide excision
alone (WEA) refers to the removal of DCIS plus the removal
of 1 centimeter of healthy tissue surrounding the DCIS in
an attempt to remove all of the abnormal cells and reduce
recurrences. This trial included 157 women with DCIS that
measured no greater than 2.5 centimeters in its widest diameter.
Five years following WEA, the rate of recurrences within the
breast of the original DCIS was 12.5%. Patients who were older
than 60 years of age and those with a greater volume of the
tumor had higher rates of recurrences than other patients.
The trial was stopped early due to the high rate of recurrences.
The researchers concluded that the use of WEA does not appear
to be appropriate treatment for patients with DCIS and radiation
should be considered as a component of the treatment regimen.
However, they noted that the recurrence rate in this group
of patients was higher than generally noted with in patients
treated with the surgical removal of DCIS. Patients with DCIS
may wish to speak with their physician about their individual
risks of treatment with excision alone or the addition of
radiation therapy to their therapeutic regimen.
Reference: Song J, Gadd M, Gelman R, et al. Wide excision
alone for ductal carcinoma in situ (DCIS) of the breast. Proceedings
from the 2003 San Antonio Breast Cancer Symposium. December
2003. Abstract #15.
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