Breast-Sparing Surgery Means More Procedures
Women with ductal carcinoma in situ (DCIS) who opt to preserve the affected breast face continued diagnostic and invasive procedures potentially for years after surgery, researchers found.
Over 10 years, more than 75% of women who underwent breast-conserving surgery subsequently had either a diagnostic mammogram or an invasive procedure in the same breast, Larissa Nekhlyudov, MD, MPH, of Harvard, and colleagues reported online in the Journal of the National Cancer Institute.
Most procedures occurred in the first six months after surgery, but about half of women still had a procedure during those 10 years even when that first half-year was excluded, they reported.
“The fact that women undergoing breast-conserving surgery are likely to have diagnostic and invasive breast procedures in the conserved breast over an extended period of time is important and needs to be included in discussions about treatment options,” they wrote.
Breast-conserving surgery is the most common treatment for DCIS, but it’s not known how often women who have the procedure have subsequent evaluations and procedures.
More than 250,000 American women will be diagnosed with breast cancer in 2010. More than half of these cases will be ductal carcinoma. Ductal carcinoma is a type of cancer that starts in the milk ducts of the breast.
There are two types of ductal carcinoma:
- Ductal carcinoma in situ, which is also referred to as intraductal carcinoma
- Invasive ductal carcinoma
So Nekhlyudov and colleagues assessed 2,948 women with DCIS who underwent breast-conserving surgery from 1990 to 2001, and who were followed for up to 10 years.
During that time, 30.8% of the women had diagnostic mammograms to evaluate new symptoms or new abnormalities on a breast exam or on surveillance mammograms.
Most women - 61.5% - also had at least one ipsilateral invasive procedure over the study period, the most common being an excisional biopsy, they found.
Women who had adjuvant radiation had the highest rate of diagnostic mammograms (34.9%) while those on tamoxifen alone had the lowest rate (22.3%). The results were similar for invasive procedures, the researchers said (64.7% and 49.2%, respectively).
Many people have said that a DCIS diagnosis is like entering Alice’s wonderland - at first, everything is confusing. Medical terms and routines are bewildering, treatments are scary, and emotions can get out of control. You can navigate through this foreign landscape. Don’t be afraid to ask for help, demand the care and attention that you need from your medical and support teams, and take time to do things for yourself.
We have tried not to overwhelm you - some readers will want more information in terms of quantity and technicality, others will find this more than enough. Hopefully, we will provide all readers with a better understanding of DCIS. We encourage you to talk with your doctor until you are comfortable with the information you have and with your decision.
Invasive procedures were most common in the first six months: 51.5% of women had them during this time, and these procedures continued at a median annual rate of 3.1%.
Most diagnostic mammograms, on the other hand, occurred during the second year after surgery (11.4%), with 7.3% of women having one in the first six months. The median annual rate was 4.3%.
DCIS – ductal carcinoma in situ
If you have ductal carcinoma in situ (DCIS), it means that cells inside some of the ducts of your breast have started to turn into cancer cells. These cells are all inside the ducts and have not started to spread into the surrounding breast tissue. So, there is very little chance that any of the cells have spread to the lymph nodes or elsewhere in the body.
Invasive ductal breast cancer and DCIS are not the same thing. In invasive ductal breast cancer, the cells have broken out of the ducts and so there is a chance they can spread into nearby lymph nodes or to other parts of the body.
In cumulative, 10-year incidence estimates, 41% of women had at least one diagnostic mammogram, 65.7% had at least one invasive procedure, and 76.1% had either event.
When excluding events that occurred during the first six months after breast-conserving surgery, 36.4% had at least one diagnostic mammogram, 30.4% had at least one invasive procedure, and 49.5% had either one over 10 years, the researchers said.