[MOL] Mastectomy unnecessary in treating ductal carcinoma in situ..... [00980] Medicine On Line

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[MOL] Mastectomy unnecessary in treating ductal carcinoma in situ.....

Mastectomy unnecessary in treating ductal carcinoma in situ

MIAMI, Mar 03 (Reuters Health) - Routine total mastectomy overtreats women with ductal carcinoma in situ (DCIS) and appears unnecessary, according to a presentation here yesterday at the 17th annual Miami Breast Cancer Conference.

Dr. Richard Margolese from the Jewish General Hospital in Montreal, Quebec, Canada, reviewed two DCIS treatment trials. One trial (B-17) compared lumpectomy alone with lumpectomy and radiation, while the other trial (B-24) compared lumpectomy and radiation with a combination of lumpectomy, radiation and tamoxifen.

In the B-17 trial, 3.9% of 818 patients undergoing lumpectomy and radiation developed recurrent invasive breast cancer. In the B-24 trial, patients receiving lumpectomy, radiation and tamoxifen had a further reduction in the rate of recurrent invasive breast cancer to about 2%.

"Tamoxifen imparts an additional advantage over radiation," Dr. Margolese said, and "reduces all invasive breast cancer recurrences, not just ipsilateral."

Metastasis without local recurrence accounted for most of the cases of invasive breast cancer in trial B-17, Dr. Margolese said, and presumably, these cancers would not have been prevented by more radical surgery.

"Historically there's an incidence of mortality from total mastectomy," he said. This is probably because "cancers that look like they're innocuous can be metastatic."

Overall, he said, the risk of developing DCIS in the opposite breast is greater than the risk of developing invasive breast cancer. The results suggest that "we might be doing mastectomies on some patients who really don't need them," Dr. Margolese concluded.

-Westport Newsroom 203 319 2700

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