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Breast surgery offers less survival benefit for patients with low-grade ductal carcinoma in-situ


In a study, researchers from Brigham and Women's Hospital ( BWH ) ( Boston, Massachusetts; USA ) have reported that breast surgery performed at or shortly after a diagnosis of low-grade ductal carcinoma in-situ ( DCIS ) did not significantly change patients' survival rate.
The team found that the survival rate for those with intermediate- and high-grade ductal carcinoma in-situ does improve with surgery, but the work raises concerns about overtreatment and the necessity and benefit of surgery for all patients with low-grade ductal carcinoma in-situ.

Until now, the benefit of surgical management for ductal carcinoma in-situ had not been investigated. Among patients with high- and intermediate-grade DCIS, researchers did see a statistical difference between the surgery and non-surgery groups, but that significant benefit was not observed for patients with low-grade DCIS.

Ductal carcinoma in-situ is a cancer of the milk ducts and is the most common type of non-invasive breast cancer. Improvements in early detection have dramatically increased the number of cases of ductal carcinoma in-situ and approximately 60,000 women are diagnosed with ductal carcinoma in-situ each year, which accounts for 20 to 25% of new breast cancer cases in the United States.

It is estimated that between 25 and 50% of ductal carcinoma in-situ cases may progress to invasive ductal carcinoma. This rate varies depending on whether a woman's DCIS is categorized as low-, intermediate- or high-grade, but the standard of care for all grades of ductal carcinoma in-situ is surgery.

The team looked at data from more than 50,000 cases of ductal carcinoma in-situ available from the SEER ( Surveillance, Epidemiology and End Results ) database collected between 1998 and 2011 at the Dana-Farber/Brigham and Women's Cancer Center.
For low-grade ductal carcinoma in-situ, the ten year survival rate for women who did not receive surgery at or shortly after diagnosis was 98.8%, and the survival rate for women who did receive surgery was 98.6%.
For women with intermediate- or high-grade ductal carcinoma in-situ, the survival rate was significantly different between those who had surgery and those who did not.

This study alone does not allow researchers to definitively conclude that breast surgery should be avoided for women with low-grade ductal carcinoma in-situ. ( Xagena )

Source: JAMA Surgery, 2015

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