Treatment

The surgeon

There are surgeons whose practice specialty is breast surgery. A woman is more likely to find such a surgeon in a major medical center. It may be important to engage a surgeon who is Board Certified in breast surgery and reconstruction.

There is still plenty of controversy over the diagnosis and treatment of DCIS. Options include: wait and see, drug therapy, breast conserving lumpectomy with or without radiation and various forms of mastectomy. A recently published study by M.N. Ibrahim et al. concludes that there is no significant difference in disease specific survival rate between total mastectomy and breast conserving surgery with radiotherapy in the treatment of carcinoma in situ. Regardless, patients should be encouraged to seek a second opinion.

Lumpectomy

Lumpectomy is a breast conserving treatment (BCT) that surgically removes all affected tissue and at least 1mm of surrounding healthy tissue. Lumpectomy in conjunction with radiation therapy has been shown to reduce local recurrence of DCIS when the mass is about 4cm in diameter or less. Lumpectomy is usually performed in the outpatient setting using local anesthesia. If the breast is large, position of the mass requires extensive manipulation or sentinel node biopsy is anticipated, general anesthesia may be required.

• The National Surgical Adjuvant Breast and Bowel Project B-17 found that the addition of radiation therapy reduced the occurence of invasive breast cancer from 13.4 to 3.9 percent.
• Meijnen, P.; Oldenburg, H.; et al. "BCT of DCIS bears the risk of residual disease progressing into invasive local recurrence and distant metastasis. A re-excision or mastectomy is therefore desired in all patients with unclear margins. Mastectomy treatment is associated with optimal local control and might be considered for patients younger than 40 years who are at high risk of local recurrence."

Mastectomy

Several studies have shown that only 1-2% of women with DCIS will die of breast cancer regardless of whether they were treated with lumpectomy or mastectomy. Therefore, mastectomy is usually reserved for cases where repeated lumpectomies fail to produce clear margins, where there are diffuse malignant appearing microcalcifications or when the breast is small and resection would result on significant deformity.

The definitions for various kinds of mastectomies can be confusing. To sort out the confusion, take a look at the Cancer Encyclopedia at this link.

Patient rights to breast reconstruction following mastectomy can be found at the following website,Women's Health and Cancer Rights Act of 1998

Radiation
The purpose of radiation therapy is to decrease the replication potential of any remaining DCIS cells. Radiation therapy involves the delivery of high energy rays to the treatment site. These rays disrupt vascular endothelium resulting in decreased tissue vascularity. The reduced vascularity deprives DCIS of the environment needed for efficient cellular reproduction.

• Rudloff, U.; Brogi, E.; McCormick, B.; et al. found, "Effect of RT on local recurrence