NEW ORLEANS Updated results from two clinical trials of ductal
carcinoma in situ (DCIS) continue to support the use of radiation therapy and
tamoxifen (Nolvadex) after lumpectomy in these patients. D. Lawrence
Wickerham, MD, associate chairman of the National Surgical Adjuvant Breast and
Bowel Project (NSABP), reported the findings at the American College of
Surgeons 87th Clinical Congress.
NSABP B-17 and B-24
Dr. Wickerham presented the most recent follow-up on NSABP protocols B-17
and B-24, both of which evaluated treatments for DCIS. Since 1993, the
diagnosis of DCIS has increased by more than 300%, thought largely due to
increased use of screening mammography. The proper treatment of this condition,
which is diagnosed in 20,000 to 30,000 women a year in the United States, has
been a subject of debate.
NSABP B-17 began in 1985 and entered more than 800 women with DCIS. Women
were randomized to either lumpectomy or lumpectomy followed by radiation
After 12 years of follow-up, the results show a 62% decrease in the
subsequent development of invasive breast cancer, and a 51% decrease in the
recurrence of DCIS in women receiving radiation therapy along with lumpectomy,
reported Dr. Wickerham, associate professor of human oncology, Medical College
of Pennsylvania/Hahnemann University, Pittsburgh.
NSABP B-24, which followed B-17, involved more than 1,800 women treated with
lumpectomy and radiation therapy. Additionally, these women were randomized to
receive tamoxifen or placebo for a 5-year period.
The 7-year results of B-24 show a 37% decrease in the incidence of invasive
breast cancer for women receiving tamoxifen. Based on earlier findings from
NSABP B-24, tamoxifen was approved as a treatment for DCIS in June 2000.