News & Commentary

Surgery for DCIS not always warranted

Frank Diamond

Too many women with ductal carcinoma in situ (DCIS) undergo lumpectomy or mastectomy, according to a study in JAMA Oncology. Researchers at the University of Toronto followed 100,000 women for 20 years who had been diagnosed with DCIS. Most women diagnosed with the disease had either a lumpectomy or mastectomy.

Laura Esserman, MD, points out in an editorial accompanying the JAMA Oncology study that “the removal of 50,000 to 60,000 DCIS lesions annually has not been accompanied by a reduction in the incidence of invasive breast cancer.” Esserman and others have called for removing the cancer label from DCIS and recategorizing it and other similar low-risk cancers as “indolent lesions of epithelial origin,” or IDLE.

Most of the women in the study had lumpectomies or mastectomies (often double mastectomies). Their chances of dying from breast cancer 20 years later was 3.3%, nearly the same as women in the general population.

However, a more aggressive approach might be the right one for younger women and blacks. For one thing, younger women getting screened are more likely to be symptomatic because screening is rare for that group. Black woman are disproportionately affected by estrogen receptor–negative breast cancer, which has a poorer prognosis than other types of breast cancer and is more difficult to treat.

Black women may still need aggressive treatment

20-year breast cancer-specific survival after ductal carcinoma in situ (DCIS) by race/ethnicity

Source: Narod SA et al., JAMA Oncology, Aug. 20, 2015


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