WHY YOU SHOULD CONSIDER A SECOND PATHOLOGY OPINION FOR DUCTAL
CARCINOMA IN SITU
By Maryann Napoli
(August 2003)
Ductal carcinoma
in situ now represents one out of every five new cases of
mammography-detected breast cancer diagnosed in the U.S.
Despite its ominous name, which means cancer within the
milk duct of the breast, DCIS is not always destined to
become deadly. Only an estimated one-third of all cases
will progress to invasive breast cancer, even if left untreated.
The massive rise in DCIS is due to the increased acceptance
of mammography screening. But the ability to diagnose DCIS
has outpaced the knowledge of how to treat it without causing
too much harm. A new study conducted in the UK, New Zealand,
and Australia provides some partial answers (The Lancet,
7/12/03).
No cancer agency keeps track of how DCIS is treated in the
U.S, but uncertainty is clearly reflected in the range of
possibilities. This microscopic lesion can be treated with
excision plus six weeks of radiation therapy, breast removal,
or excision alone. There is also a great deal of uncertainty
about the use of the anti-breast cancer hormonal drug tamoxifen
following the initial treatment.
The new study conducted by the UK Coordinating Committee
on Cancer Research set out to determine which treatment
or treatment combination results in a lower rate of recurrence.
All of the 1,694 participants had an excisional biopsy and
were then given either no further treatment, radiation therapy,
or tamoxifen, or both. The recurrence rate was lower in
the women given radiation therapy, as compared to women
treated with surgical excision alone. But the difference
between the two groups was small:TInvasive
breast cancer occurred in the affected breast of 2.5% of
the women given radiation therapy, compared with 5.3% in
the excision alone group.
The median follow-up
for this study was only four years--too short a time to
know whether radiation therapy actually extends life, or
if the adverse effects of radiation itself outweigh the
reduced chance of recurrence. (Earlier research showed a
slight increase in cardiovascular deaths among younger women
given radiation therapy.) This study will have the unfortunate
effect of reinforcing the current "treat all to decrease
recurrences in a tiny minority" approach to radiation.
As for tamoxifen, the new study found little evidence to
support its use.
Two of the country's leading breast pathologists have long
been working on ways to distinguish which forms of DCIS
will become invasive and which will remain dormant. Consider
a second pathology opinion from Michael Lagios, MD, San
Francisco (415)789-0965(www.breastcancerconsultdr.com),
or David Page, MD, Vanderbilt University, Tennessee (615)343-0072
(www.breastconsults.com).
Both will deal directly with breast cancer patients.
