Many tests follow surgery for early breast cancer

By Amy Norton

NEW YORK (Reuters Health) – Women who have early breast tumors surgically removed may often go through repeat mammograms and invasive procedures for years afterward, a new study finds.

The study focused on ductal carcinoma in situ, or DCIS, for which the most common treatment is breast-conserving surgery. Researchers found that of nearly 3,000 women who had the surgery between 1990 and 2001, two-thirds ended up having at least one more invasive procedure over the next decade — usually a biopsy to remove abnormal tissue in the same breast.

However, just 8% actually had a DCIS recurrence over the years and another 8% developed invasive breast cancer.

The report, released online April 5th in the Journal of the National Cancer Institute, points to a downside of breast-conserving surgery for DCIS.

“Women making treatment decisions about DCIS need to understand that many women will need additional surgery or invasive intervention after breast-conserving surgery,” said Dr. Joshua Fenton of the University of California, Davis in Sacramento, who co-wrote an editorial published with the study.

“We’re not suggesting that women have a mastectomy instead,” said study leader Dr. Larissa Nekhlyudov, of Harvard Medical School in Boston. Instead, she told Reuters Health, women should be aware that breast-conserving surgery can come with a long follow-up.

“The good news is that the majority of these women will not have a (cancer) recurrence,” Dr. Nekhlyudov said. “But the work-ups for a possible recurrence are likely to continue for years.”

Whether women choose a mastectomy or breast-conserving surgery, the prognosis is “excellent,” Dr. Fenton said in an email. But that means that other factors, like the need for follow-up procedures, have to be considered, according to Dr. Nekhlyudov.

The findings fit into the bigger issue of the pros and cons of mammography screening for breast cancer. In the United States, the government-backed U.S. Preventive Services Task Force recommends screening women ages 50 to 74 every other year. Some medical groups, though, call for regular mammograms for all women starting at age 40.

Since mammography screening came into widespread use in the 1980s, the number of DCIS diagnoses has shot up.

DCIS is almost always caught because of mammography screening, Dr. Fenton said, and about one in five newly diagnosed breast cancers is DCIS. The problem is that DCIS may or may not progress to tumors that invade the breast tissue. And right now, there’s no way to predict which cases will progress.

It’s not possible to tell whether the women underwent “too many” procedures over time, both Dr. Fenton and Dr. Nekhlyudov said.

But Dr. Fenton pointed out that half of the women had an invasive procedure in the same breast within six months of surgery. Most, he said, were probably re-excisions to ensure clear margins.

Studies have found that rates of such re-excisions vary widely from hospital to hospital, and surgeon to surgeon, Dr. Fenton said.

“This implies the need for better agreement about when women receiving breast-conserving surgery need additional early surgery,” he said.

Active surveillance is not an option for DCIS yet, since there’s no way of telling which tumors might progress quickly. But it could become one if researchers find certain tumor characteristics that strongly predict it’s benign, Dr. Fenton said.

It will also probably take a “cultural shift,” Dr. Nekhlyudov noted, since people typically want aggressive treatment for cancer, even if it’s early-stage.

It’s been estimated that by 2020, one million U.S. women will be living with a diagnosis of DCIS.

SOURCE: http://bit.ly/IEYv3o

J Natl Cancer Inst 2012.