Lumpectomy Compared with Lumpectomy and Radiation Therapy for the Treatment of Intraductal Breast Cancer

Fisher, Bernard; Costantino, Joseph P.; Redmond, Carol; Fisher, Edwin R.; Margolese, Richard G.; Dimitrov, Nikolay V.; Wolmark, Norman; Wickerham, D. Lawrence; Deutsch, Melvin; Ore, Liora; Mamounas, Eleftherios P.; Poller, William R.; Kavanah, Maureen

doi:10.1056/nejm199306033282201

Cited by 686 publications

(337 citation statements)

References 17 publications

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“…Radiation after breast-conserving treatment reduces recurrences in the ipsilateral breast (Fisher et al, 1993;Julien et al, 2000), but its effect on the risk of new (ipsi-or contralateral) breast cancer is less conclusive (Warnberg et al, 2001;Claus et al, 2003). We found only a slightly increased risk of second breast cancer after radiation that was not significantly different from that of patients without radiotherapy.…”

Section: Determinantscontrasting

confidence: 47%

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Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

et al. 2006

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Among 1276 primary breast carcinoma in situ (BCIS) patients diagnosed in 1972 -2002 in the Southern Netherlands, 11% developed a second cancer. Breast carcinoma in situ patients exhibited a two-fold increased risk of second cancer (standardised incidence ratios (SIR): 2.1, 95% confidence interval (CI): 1.7 -2.5). The risk was highest for a second breast cancer (SIR: 3.4, 95% CI: 2.6 -4.3; AER: 66 patients per 10 000 per year) followed by skin cancer (SIR: 1.7, 95% CI: 1.1 -2.6; AER: 17 patients per 10 000 per year). The increased risk of second breast cancer was similar for the ipsilateral (SIR: 1.9, 95% CI: 1.3 -2.7) and contralateral (SIR: 2.0, 95% CI: 1.4 -2.8) breast. Risk of second cancer was independent of age at diagnosis, type of initial therapy, histologic type of BCIS and period of diagnosis. Standardised incidence ratios of second cancer after BCIS (SIR: 2.3, 95% CI: 1.8 -2.8) resembled that after invasive breast cancer (SIR: 2.2, 95% CI: 2.1 -2.4). Surveillance should be directed towards second (ipsi-and contra-lateral) breast cancer.

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Section: Determinantscontrasting

confidence: 47%

“…We found only a slightly increased risk of second breast cancer after radiation that was not significantly different from that of patients without radiotherapy. Thus, the benefit of radiation after surgery for the overall survival of DCIS patients seems to outweigh the increased risk of second breast cancer (Fisher et al, 1993).…”

Section: Determinantsmentioning

confidence: 99%

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

et al. 2006

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“…Approximately half of the local recurrences after treatment for a primary DCIS are invasive (Rosen et al, 1980;Page et al, 1982;Bradley et al, 1990;Price et al, 1990;Graham et al, 1991;Swain, 1992;Fisher et al, 1993;Solin et al, 1996). Autopsy studies, however, strongly suggest that not all DCIS lesions progress to invasiveness during a patient's lifetime (Andersen et al, 1985).…”

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confidence: 99%

Tumour markers in breast carcinoma correlate with grade rather than with invasiveness

Wärnberg

Nordgren

Bergkvist³

et al. 2001

Br J Cancer

105

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Summary Ductal breast carcinoma in situ (DCIS) is regarded as a precursor to invasive breast cancer. The progression from in situ to invasive cancer is however little understood. We compared some tumour markers in invasive and in situ breast carcinomas trying to find steps in this progression. We designed a semi-experimental setting and compared histopathological grading and tumour marker expression in pure DCIS (n = 194), small invasive lesions (n = 127) and lesions with both an invasive and in situ component (n = 305). Grading was done according to the Elston-Ellis and EORTC classification systems, respectively. Immunohistochemical staining was conducted for p53, c-erbB-2, Ki-67, ER, PR, bcl-2 and angiogenesis. All markers correlated with grade rather than with invasiveness. No marker was clearly associated with the progression from in situ to invasiveness. The expression of tumour markers was almost identical in the 2 components of mixed lesions. DCIS as a group showed a more 'malignant picture' than invasive cancer according to the markers, probably, due to a higher proportion of poorly differentiated lesions. The step between in situ and invasive cancer seems to occur independently of tumour grade. The results suggest that well-differentiated DCIS progress to well-differentiated invasive cancer and poorly differentiated DCIS progress to poorly differentiated invasive cancer.

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“…The National Surgical Adjuvant Breast and Bowel (NSABP) trial B17 was the first large randomized trial to compare excision alone to excision plus adjuvant radiation for DCIS of the breast [8]. This trial randomized 818 women with DCIS and uninvolved margins to wide local excision with or without adjuvant radiotherapy and showed a decrease in ipsilateral recurrence at 90 months follow-up from 27% to 12% with the addition of radiotherapy [9].…”

Section: Discussionmentioning

confidence: 99%

Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast

et al. 2001

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SUMMARY In order to assess the utility of margin width in relation to other histopathologic features as a determinant of local control in ductal carcinoma in situ (DCIS) of the breast, we retrospectively examined the treatment of 109 breasts treated with (n ‫؍‬ 54) or without adjuvant radiotherapy (n ‫؍‬ 55). Median follow-up was 49 and 54 months for patients treated with excision alone (E) or excision plus adjuvant radiotherapy (E؉XRT), respectively. Cases treated with E؉XRT were significantly larger and had a trend towards closer surgical margins than those treated with E alone. For all cases, margin width <1 mm and lesion diameter >15 mm were significantly associated with increased local recurrence. Lesion size <15 mm was associated with no cases of local failure regardless of treatment arm. For lesions >15 mm in diameter, there was a significant decrease in 5-year local failure with E؉XRT compared to E alone (21% vs. 36%, P ‫؍‬ 0.03). Tumor margin >1 mm was associated with a low rate of 5-year local failure for either E alone or E؉XRT (10.9% vs. 4.6%, P ‫؍‬ NS). Tumor margin <1 mm had a high rate of local failure that was not significantly decreased by the addition of adjuvant radiotherapy. These results show that large diameter (>15mm) and close surgical margins (<1 mm) are the dominant risk factors for local recurrence in DCIS. E؉XRT significantly decreased local failure risk compared to E alone for large lesions but not for those with close margins.

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Lumpectomy Compared with Lumpectomy and Radiation Therapy for the Treatment of Intraductal Breast Cancer

Abstract: Breast irradiation after lumpectomy is more appropriate than lumpectomy alone for women with localized ductal carcinoma in situ.

Cited by 686 publications

References 17 publications

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

Increased risk of second malignancies after in situ breast carcinoma in a population-based registry

Tumour markers in breast carcinoma correlate with grade rather than with invasiveness

Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast

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