Combination surgery and radiotherapy benefits all women with DCIS

NEW YORK (Reuters Health) - A literature review "confirms the benefit of adding radiotherapy to breast-conserving surgery for the treatment of all women diagnosed with ductal carcinoma in situ (DCIS);" this strategy substantially reduces the risk of breast cancer recurrence.

The review, conducted by Dr. Annabel Goodwin at The University of Sydney in Camperdown, Australia, and colleagues, is published in the latest online issue of The Cochrane Library, a publication of The Cochrane Collaboration.

Dr. Goodwin's group searched the Cochrane Breast Cancer Group Specialized Register (January 2008); the Cochrane Central Register of Controlled Trials (2008); MEDLINE (February 2008); EMBASE (February 2008) and abstracts from major cancer conferences.

The investigators identified four well-designed, randomized controlled trials involving 3,925 women that compared the addition of radiotherapy to breast-conserving surgery.

"All the subgroups analyzed benefited from addition of radiotherapy," Dr. Goodwin and colleagues report.

There was a statistically significant benefit with the addition of radiotherapy on all ipsilateral breast events, with a hazard ratio of 0.49, and ipsilateral DCIS recurrence, with a hazard ratio of 0.64. Recurrence of invasive cancer did not reach statistical significance.

There was no significant long-term toxicity from radiotherapy and no reports of short-term toxicity or adverse effects on the quality of life.

In a comment from the Health Behavior News Service, Dr. Monica Morrow of Memorial Sloan-Kettering Cancer Center in New York, New York, said that the review confirms what is currently recommend by most physicians for their patients with DCIS who undergo breast-conserving treatment.

"The best way to minimize the chance of recurrence is with radiation," Dr. Morrow said.

Most physicians will recommend breast-conserving surgery for DCIS. However, "studies show that the bigger the patient's role in decision-making, the greater the likelihood the patient will end up with mastectomy," she said.

"This is because most patients don't distinguish between DCIS and invasive breast cancer, because a lot of the stuff they find on the Internet is written about invasive cancer."

Dr. Morrow pointed out that there is little difference in survival rates between mastectomy and breast-conserving surgery for women with DCIS.

"What I tend to emphasize to my patients with DCIS is that no matter which treatment they choose, their risk over the next 15 years of dying of something else is greater than their risk of dying of breast cancer."

Cochrane Database of Systematic Reviews 2009.

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