Surgery without radiation might not be best course
Many women with a noninvasive form of breast cancer have chosen in recent years to undergo only surgery. Radiation was not necessary, they were told. That advice may have been wrong.
A Harvard University study of women with ductal carcinoma in situ (small tumors of the milk ducts) has found a “surprisingly high rate of recurrence” among a small group of patients who opted for surgery alone.
The finding suggests that all such patients -- 50,000 are diagnosed annually in the United States -- should consider additional treatment with radiation. About a third of women with the form of breast cancer, called DCIS, are treated solely with surgical removal, most often breast-preserving lumpectomy, federal data show.
Based on the new findings, Harvard-affiliated hospitals are routinely giving radiation therapy to DCIS patients, said senior study author Dr. Jay R. Harris, chief of radiation oncology at Dana-Farber Cancer Institute and Harvard Medical School in Boston.
It’s unclear how the study results will affect decision-making elsewhere.
Researchers at Dana-Farber and Brigham and Women’s Hospital, both Harvard teaching hospitals, in 1994 began studying the outcomes for patients who had surgery alone for DCIS, hopeful that women would do fine without daily radiation, which is inconvenient, expensive and can affect the breast’s appearance.
That expectation was bolstered after Dr. Melvin J. Silverstein, medical director of the Harold E. and Henrietta C. Lee Breast Center at USC, published an important study in the May 13, 1999, New England Journal of Medicine showing DCIS patients who had a wide margin of healthy tissue removed from around their tumors (at least 10 millimeters) had no higher rate of recurrence than those who also underwent radiation. Silverstein reported only three recurrences among 133 women who had surgery alone and were followed an average of more than six years.
But in a presentation Dec. 3 at the San Antonio Breast Cancer Symposium, Dr. Julia Wong, a radiation oncologist at Dana-Farber and Brigham and Women’s, reported that 13 of 157 DCIS patients who were treated at Harvard hospitals and followed an average of 3 1/2 years after surgery developed same-breast recurrences; four had invasive cancer.
Asked about the findings, Silverstein reiterated his opposition to routine radiation for DCIS. For low-risk patients with small tumors and wide surgical margins, the financial and physical costs of radiation “may far outweigh potential benefits.”
He also said that no study of DCIS has shown that radiation therapy improved survival compared with surgery alone.
Harris suggested that patients concerned about not having received radiation be closely monitored and undergo twice-yearly mammograms.
