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No Survival Benefit for Mastectomy Over Breast-Conserving Surgery in DCIS Patients

No Survival Benefit for Mastectomy Over Breast-Conserving Surgery in DCIS Patients

HAMBURG, Germany—More than 90% of woman diagnosed with ductal carcinoma in
situ (DCIS) will still be alive 10 years after diagnosis and treatment,
regardless of how they were initially treated. Research data confirming these
findings were presented at the 4th European Breast Cancer Conference
(abstract 461).

Dennis R. Holmes, MD, assistant professor of clinical surgery, University
of Southern (USC) California Keck School of Medicine, said that the study
results offer reassuring evidence to woman with DCIS who opt for lumpectomy.
"Choosing lumpectomy over mastectomy will not make any difference to their
chances of surviving the disease," he said. "However, this outcome is
dependent on doctors keeping a close eye on the patient after treatment, with
regular screenings and early detection of any recurrence."

Dr. Holmes and his colleagues from the Van Nuys Breast Center and USC Norris
Comprehensive Cancer Center and Hospital (led by Melvin J. Silverstein, MD)
studied data from 1,136 patients who had been treated for DCIS and followed for
10 years. Treatment started as far back as 1971. Among these patients, 236 had
a lumpectomy followed by postoperative radiotherapy, 444 received lumpectomy
only, and 406 underwent mastectomy.

After 10 years, 129 patients (11.4%) had a recurrence: 18% of the
lumpectomy/radiotherapy patients, 30% of the lumpectomy-only patients, and
1.8% of the mastectomy patients. Invasive recurrences were reported in 57
patients (2%, 1.2%, and 1%, respectively). The researchers reported eight
breast-cancer-related deaths: six (2%) in the lumpectomy/radiotherapy
patients, and two (0.7%) in the lumpectomy-only group. There were no
breast-cancer-related deaths reported in the mastectomy group.

"These results show that nearly all patients with DCIS whose cancer recurs
can be treated successfully, whether DCIS recurs as a new DCIS or an invasive cancer," Dr. Holmes
concluded. "In the small subgroup of patients who develop invasive breast
cancer, the chances of surviving 10 years are better than 90%. This is similar
to patients diagnosed with small (T1a or T1b) node-negative cancers."

He noted that many studies comparing mastectomy with breast
conservation show that mastectomy is associated with a lower risk of local
recurrence. "But mastectomy does not provide a survival advantage when compared
to breast-conservation therapy," he said. "Our findings show that 730
additional mastectomies would have to be performed to achieve a
breast-cancer-specific mortality rate of zero in woman diagnosed with DCIS."

Dr. Holmes believes that this mastectomy rate is
unattainable, because mastectomy "may be an undesirable option for many women
who are willing to accept a higher risk of local recurrence as long as it does
not place them at a higher risk of death."

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