Considering the prevalence of Ductal Carcinoma in Situ (DCIS), it is important to know more about it. This article discusses the treatment options and also the common misconceptions related to this condition. It also examines the risks and benefits of each treatment option.
Lumpectomy with radiation
Currently, lumpectomy with radiation for Ductal Carcinoma in Situ (DCIS) is the standard treatment for early-stage invasive breast cancer. However, a number of studies have suggested that lumpectomy without radiation therapy might be appropriate in certain patients. In this article, we review the results of two recent studies that suggest that women with a favorable prognosis of DCIS may be able to avoid radiation therapy.
First, a review of slides from a pathology center revealed that invasive cancers occurred in only 1.5 percent of primary tumors. However, this result did not reflect the true incidence of invasive tumors. Rather, it could have been due to a sampling error. Second, radiation therapy reduced the incidence of second ipsilateral tumors. However, there was little evidence to indicate that radiation therapy improved overall event-free survival.
In addition, lumpectomy without radiation therapy did not result in a lower incidence of invasive tumors. Instead, women who had lumpectomy and radiation therapy had a 2.9 percent and a 7.5 percent cumulative incidence of ipsilateral cancers, respectively.
While the cumulative incidence of first ipsilateral cancers in women who had a lumpectomy with radiation was low, the cumulative incidence of second ipsilateral cancers was much higher. However, radiation therapy was also effective at reducing the incidence of second noninvasive tumors.
In addition, radiation therapy reduced the incidence of regional metastases. However, a recent study comparing radiation therapy after lumpectomy with lumpectomy alone for women with ductal carcinoma in situ found that overall event-free survival was significantly improved in the radiation therapy group. In addition, the overall breast failure rate was significantly lower in women who had lumpectomies with radiation therapy.
Finally, a recent study has suggested that radiation therapy might be less effective for women over 70 with ER+ invasive breast cancer. However, the results of this study suggest that radiation therapy might be effective for younger women with DCIS.
Regardless of the conclusion, the fact remains that lumpectomy with radiation therapy for Ductal Carcinoma in situ is an effective treatment for women with this condition. However, further studies are needed to determine whether it is appropriate for certain patients.
Mastectomy
Choosing a mastectomy for DCIS may be a difficult decision. Mastectomy is a major surgical procedure that removes the entire breast, including the lymph nodes under the arm. The main goal of surgery for DCIS is to reduce the risk of developing invasive cancer in the same breast.
There are several factors that determine which type of surgery to choose. The size and location of the tumor are some of the factors that are considered by healthcare providers. Some patients may need additional treatments, such as chemotherapy or targeted therapy.
Some people may also need hormone therapy. It’s important to discuss the risks and benefits of these treatments with your healthcare provider.
Mastectomy is often the best option for patients with large tumors. Women may also choose to undergo breast reconstruction during or after a mastectomy. The decision depends on several factors, including the size of the tumor and the patient’s age and health.
If the cancer is detected early, the chances of successfully curing the tumor are increased. DCIS can be treated with surgery, radiation therapy, or medicines. Surgical treatments include breast-sparing surgery, lumpectomy, and mastectomy. The type of surgery you choose depends on a number of factors, including your age, your health, and what you want your breast to look like.
A mastectomy for DCIS is an option that may be worth considering. Mastectomy is often effective in treating this type of cancer, and it’s unlikely that cancer will return. However, you should be aware that a mastectomy does not guarantee that you will not receive radiation therapy. It may also cause muscle loss and lymphedema.
While breast-sparing surgery is often effective for DCIS, a mastectomy may be the better option for some patients. A mastectomy may be required if the cancer is large, or if the cancer is spread throughout several milk ducts. Mastectomy may also be the best option if cancer has spread to the chest wall, or if the cancer is in more than one quadrant of the breast.
When choosing a mastectomy for DCIS, keep in mind that it may still require radiation therapy. The goal of radiation therapy is to prevent cancer from returning.
Breast-conserving therapy
Traditionally, patients with DCIS have been treated with breast-conserving surgery and adjuvant endocrine therapy. However, many patients don’t benefit from this type of therapy. The goal of treatment is to prevent a recurrence.
Invasive breast cancer occurs when the abnormal cells in DCIS break through the ductal basement membrane and spread into the surrounding breast tissue. It is rare for DCIS to spread to the lymph nodes. But in rare cases, a sentinel lymph node biopsy may be performed during a mastectomy.
The most common treatment for DCIS is breast-conserving surgery, also known as lumpectomy. This surgery is followed by radiation therapy to eliminate any residual cancer.
The American Society of Clinical Oncology and the Society of Surgical Oncology has published a consensus guideline for breast-conserving therapy. The goal of this therapy is complete resection with negative margins. The operation is usually performed under general anesthesia. The surgeon is guided by an X-ray or ultrasound scan to mark the precise position of the DCIS.
The study used seven-gene predictive DCIS biosignature to identify a subgroup of patients who could benefit from breast-conserving surgery and endocrine therapy. This group includes women who have had a bilateral mastectomy or who are younger than 40 years old.
The study is part of a large multinational consortium funded by Cancer Research UK and the Dutch Cancer Society. This collaboration is an international effort to prevent the overtreatment of DCIS. The results need to be validated to transform clinical practice.
Invasive recurrence was 6.5 percent in patients over 40 years of age. For patients under 40 years, invasive recurrence was 16 percent.
Invasive recurrences are different for every individual DCIS lesion. They vary in progression, histology, and genetic features. Consequently, it is difficult to separate harmless lesions from potentially invasive lesions.
Invasive recurrence is rare for patients with high-grade DCIS. The disease is graded based on how different the abnormal cells are from normal breast cells. This grade is used to determine the likelihood that the DCIS will develop into invasive cancer.
Invasive recurrences were also lower for patients who had a longer period of time since their last breast cancer treatment. This was seen in the study of 2996 women who had undergone breast-conserving surgery over a 30-year period.
Overdiagnosis and overtreatment
Despite being a rare condition, DCIS has become a concern for many women. Approximately 60,000 women are diagnosed with DCIS each year in the USA.
In the United Kingdom, approximately 7000 women are diagnosed with DCIS each year. Treatment for DCIS includes breast-conserving surgery and adjuvant endocrine therapy. However, overdiagnosis and overtreatment are growing problems. These are unnecessary costs to society and cause emotional and physical harm to patients.
A large multinational consortium funded by Cancer Research UK and the Dutch Cancer Society has been working to address overdiagnosis and overtreatment of DCIS. The PRECISION project aims to reduce the burden of overdiagnosis and overtreatment by developing a robust means of predicting which DCISs require treatment. These studies should be validated to change clinical practice.
The researchers identified 29 genes that may be associated with the development of invasive cancer. These included genes that are involved in cell cycle control, DNA repair, and invasive capacity. Several of these genes are also associated with the progression of DCIS. Several studies have shown that the expression of these genes is altered in invasive cancers of different grades.
The researchers found that a high expression of the p53 gene was associated with the development of recurrence. In addition, a low expression of BCL-2 and a high Ki-67 were associated with recurrence. However, the value of these genes has not been established. The authors suggest that further functional studies are needed to determine the role of these changes.
These findings suggest that further clinical studies should be conducted to determine whether reclassification of DCIS may prevent the occurrence of overtreatment. In particular, removing ‘pre-invasive breast cancer cells from the tumor may reduce overdiagnosis and overtreatment.
In addition, the authors suggest that clinical research should be integrated with genetic studies and functional studies. These studies should be performed on large cohorts of patients with DCIS. This will allow the researchers to better understand how changes in the microenvironment can affect tumor progression. In addition, a reclassification of DCIS may allow the researchers to determine which DCIS requires treatment.
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