Results of treating ductal carcinoma in situ of the breast with conservative surgery and radiation therapy

Ductal carcinoma in situ (DCIS) is a breast cancer arising in the ducts that has not yet invaded surrounding tissue. In the past, the specter of breast cancer was sufficiently ominous that virtually all cases of DCIS were treated with mastectomy. This treatment has been reviewed in recent years, in no small part due to the fact that the growth of mammography is turning up larger numbers of DCIS than were ever diagnosed at such an early stage in the past. Breast-conserving surgery is becoming more popular, but experience with breast-conserving surgery for DCIS is still limited. For this reason, the authors report their experience treating DCIS with conservative surgery and radiation therapy during the period from 1976 to 1985. During this period, 38 patients were diagnosed at a median age of 49 years. In 20 of the patients, the tumor was detectable only by mammography. The tumor was surgically removed in all patients and the tumor bed was treated with an average dose of 6,400 cGy of radiation. An important aspect of the treatment of DCIS is the success of salvage treatment if the cancer recurs after the initial surgery and radiotherapy. In the present study, the cancer recurred in eight patients. These patients underwent mastectomy, and all but one are presently free of disease after a follow-up ranging from 1 to 73 months. Reported local recurrence rates for DCIS after mastectomy range from 0 to 2 percent. Mastectomy, therefore, remains the ''gold standard'' against which other treatments are compared. Only the patient can decide how to balance the small but real risks with the palpable benefits of breast-conserving surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)