Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

Abstract

physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30 -84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS þ RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS þ RT and mastectomy, respectively, Po0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS þ RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20 -37%; adjuvant RT, 84 -96%; hormone treatment, 6 -34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.

A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years

“…Studies from the US SEER database also show an increased use of BCS, reaching around 70% in 2008 [10,12,14]. BCS rates in three observational studies from France, Australia and Canada show similar results [15][16][17]. In a recent report from the International Cancer Screening Network (ICSN), the BCS rate was 67-90% among screen-detected DCIS [18].…”

The management of ductal intraepithelial neoplasia (DIN): open controversies and guidelines of the Istituto Europeo di Oncologia (IEO), Milan, Italy

“…A logical and consequent conclusion from these low percentages, would be that AD should never be indicated as first treatment in DIN patients. However, both in theory and in practice it happens the contrary [34,[59][60][61]. In the light of these analyses, we can conclude that AD should no longer be performed as a first indication of treatment in patients with pure DIN and that AD should be considered in these cases an unnecessary overtreatment without any rational justification.…”

“…Treatment with radiation and tamoxifen can reduce the risk of recurrence, including invasive recurrence, but for the overall population of patients with DIN, such risk reduction comes with the knowledge that most patients would be over- The variations on DIN management in practice, demonstrated, for example, by the ASTRO/ESTRO investigation [8], the UK Sloane Project [60]and the French experience [61] show that breast cancer 16 professionals are not convinced about the optimal method to treat DIN patients. New large trials are needed in order to evaluate the best management of DIN which is in most respects still complex and controversial.…”

Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

“…(10) It is estimated that mastectomy is performed in approximately one third of DCIS cases. (11,12,13) Complete axillary node dissection is not recommended in the absence of evidence of invasive breast cancer or proven axillary metastatic disease in patients with apparent pure DCIS or mammographically detected …”