Breast-Sparing Surgery Means More Procedures
They concluded that the frequency of ongoing diagnostic breast evaluations and procedures after surgery should be included in discussions about treatment.
One limitation of the study, they added, is that it potentially underestimates imaging and invasive procedures because women who had a full mastectomy within six months of breast-conserving surgery were excluded. It may also be limited in its generalizability because the data are from only three healthcare delivery systems, they said.
In an accompanying editorial, Joann Elmore, MD, MPH, of the University of Washington in Seattle, and Joshua Fenton, MD, of the University of California Davis in Sacramento, Calif., agreed that these data should be incorporated into the decision-making process about breast-conserving surgery.
How is ductal carcinoma in situ diagnosed?
Commonly, ductal carcinoma in situ does not cause the formation of a lump in the breast that can be felt upon examination. Other signs and symptoms include breast pain and or a bloody discharge from the nipple. About 80% of cases are found by mammograms. Mammograms detect tiny bits of calcium that develop in dead cancer cells. As more and more cancer cells age and die, these calcifications grow. On the mammogram, they appear as a shadowy area.
If your mammogram suggests that you may have ductal carcinoma in situ, your doctor should recommend a biopsy. The purpose of the biopsy is to analyze the cells in the suspicious area for cancer and confirm the diagnosis. Biopsies for DCIS are typically done using needles to remove tissue samples from the breast.
After confirming that you have ductal carcinoma in situ, your doctor may recommend other tests. These tests may include an ultrasound or MRI of the breast to gather more information about your cancer. Based on the results of various tests, your doctor will be able to determine the size of your tumor and how much of your breast is involved in the cancer.
“Women who choose to preserve their breasts with breast-conserving surgery may be embarking on a more extended journey than anticipated,” they wrote. “Unfortunately, not all women may be aware of this potential outcome when they consider their treatment options.”
“Concerns about the substantial risk of subsequent invasive procedures may possibly sway more women to choose initial mastectomy over breast-conserving surgery,” they wrote.
The study was supported by grants from the National Cancer Institute.
Neither the researchers nor the editorialists reported any conflicts of interest.
Primary source: Journal of the National Cancer Institute
Source reference: Nekhlyudov L, et al “Ten-year risk of diagnostic mammograms and invasive breast procedures after breast-conserving surgery for DCIS” J Natl Cancer Inst 2012; DOI: 10.1093/jnci/djs167.
Additional source: Journal of the National Cancer Institute
Source reference: Elmore JG, Fenton JJ “Ductal carcinoma in situ: raising signposts on an ill-marked treatment path” J Natl Cancer Inst 2012; DOI: 10.1093/jnci/djs184.