Researchers at Brigham and Women’s Hospital (MA, USA) have reported recently in Jama Surgery that patient survival rate did not significantly change following breast surgery performed at or shortly after a diagnosis of low-grade ductal carcinoma in situ (DCIS). Although surgery did improve survival rates among those with intermediate- and high-grade DCIS, the study raises concerns regarding overtreatment and whether all low-grade DCIS patients need or benefit from surgery.
“Until now, the benefit of surgical management for DCIS had not been investigated – we didn’t know the impact of such surgery for this very early breast cancer. By using registry data, we could estimate the benefit,” remarked corresponding author Yasuaki Sagara of the Brigham and Women’s Hospital Department of Surgery and Dana Farber/Brigham and Women’s Cancer Center. “Among patients with high- and intermediate-grade DCIS, we do see a statistical difference between the surgery and non-surgery groups, but that significant benefit was not observed for patients with low-grade DCIS,” continued Sagara.
DCIS is the most common type of noninvasive breast cancer, and improvements in early detection have led to a dramatic rise in the number of cases – approximately 60,000 women are diagnosed with DCIS annually (20–25% of new breast cancer cases in the USA). The current standard of care for all grades of DCIS is surgery.
“We are over treating 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,” commented senior author Mehra Golshan(Dana-Farber/Brigham and Women’s Cancer Center).
The study team analyzed data from >50,000 DCIS cases available from the Surveillance, Epidemiology and End Results database that were collected at the Dana-Farber/Brigham and Women’s Cancer Center between 1998 and 2011.The 10-year survival rate for women diagnosed with low-grade DCIS but who did not receive surgery at or shortly after diagnosis was 98.8%, while the survival rate for women who did receive surgery was 98.6%. By contrast, the survival rate for women with intermediate- or high-grade DCIS was significantly different between those who received surgery and those who did not.
“This study alone does not allow us to definitively conclude that breast surgery should be avoided for women with low-grade DCIS, but we believe that a prospective clinical trial – following patients over time from diagnosis through treatment and beyond – is warranted,” concluded Sagara.