Surgery Not Always Needed for Early Form of Breast Cancer: Study

No difference found in survival for women with low-grade DCIS who did or did not have surgery

By Robert Preidt

Wednesday, June 3, 2015

WEDNESDAY, June 3, 2015 (HealthDay News) -- Surgery for a very early type of breast cancer does not significantly improve outcomes for patients, according to research that raises questions about the overuse of surgery for the condition.

Investigators examined data on more than 50,000 cases of what's known as ductal carcinoma in situ (DCIS), a very early form of cancer of the milk ducts. According to a team from Brigham and Women's Hospital in Boston, DCIS is the most common type of noninvasive breast cancer.

The approximately 60,000 women diagnosed with DCIS each year in the United States represent 20 to 25 percent of all breast cancer cases, the researchers said. Surgery remains the standard of care for all grades of DCIS, but the investigators questioned that approach.

The study was led by Dr. Yasuaki Sagara, a surgeon at Brigham and Women's Hospital and Dana-Farber/Brigham and Women's Cancer Center. His team found that for women with low-grade DCIS, the 10-year survival rate was 98.8 percent for those who had surgery at the time of diagnosis or shortly after, and 98.6 percent for those who did not have surgery -- no real difference.

However, for women with intermediate- or high-grade DCIS, the survival rate did differ significantly between those who had surgery and those who did not, according to the study published June 3 in the journal JAMA Surgery.

Study senior author Dr. Mehra Golshan is director of Breast Surgical Services at Dana-Farber/Brigham and Women's Cancer Center. He believes that "we are overtreating breast cancer in the United States, and this study, along with others, suggests the need for treatment strategies tailored to a woman's specific cancer, not just breast cancer in general."

"This study alone does not allow us to definitively conclude that breast surgery should be avoided for women with low-grade DCIS," Sagara added. However, "we believe that a prospective clinical trial -- following patients over time from diagnosis through treatment and beyond -- is warranted," he said.

Two breast cancer experts differed in their reactions to the findings.

"I agree that low-grade ductal carcinoma in situ is being overtreated in the U.S.," said Dr. Alison Estabrook, chief of breast surgery at Mount Sinai-Roosevelt Hospital in New York City. "This is an excellent paper which gives us data to use in discussing surgery or just mammographic follow up with our patients who have low-grade DCIS."

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, was more cautious, however.

"When dealing with DCIS, it is hard to use survival as the [study] endpoint," she said. "A more important endpoint, that was not observed in this study, is whether or not there was a decrease in the number of invasive cancers that were diagnosed if DCIS went untreated.

"Perhaps women that have untreated DCIS go on to developing an invasive cancer that requires more aggressive surgery, chemotherapy, with added risks," Bernik explained. "To only look at the endpoint of survival, without looking at how a woman got there, is far from equivalent."

SOURCES: Alison Estabrook, M.D., chief of breast surgery, Mount Sinai-Roosevelt Hospital, and professor, surgery, The Icahn School of Medicine at Mount Sinai, New York City; Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Brigham and Women's Hospital, news release, June 3, 2015

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