April 13 Women who have early breast tumors
surgically removed may often go through repeat mammograms and
invasive procedures for years afterwards, with two-thirds having
at least one more invasive procedure over the next decade,
according to a U.S. study.
The study, which covered nearly 3,000 women, focused on
so-called ductal carcinoma in situ, or DCIS - abnormal cells in
the milk ducts that are considered the earliest stage of breast
cancer. The most common treatment involves removing only the
abnormal tissue and conserves the breast.
But researchers said the findings, which appeared in the
Journal of the National Cancer Institute, pointed 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
Joshua Fenton, an assistant professor at the University of
California, Davis, who co-wrote an editorial published with the
The most common invasive procedure is usually a biopsy to
remove abnormal tissue in the same breast.
Of the 2,948 women in the study, all of whom had
breast-conserving surgery for DCIS between 1990 and 2001, 41
percent had at least one mammogram to check out symptoms or a
suspicious lump. And 66 percent had at least one invasive
But only eight percent actually had a DCIS recurrence and
another eight percent were found to have invasive breast cancer.
Larissa Nekhlyudov at Harvard Medical School and Harvard
Vanguard Medical Associates in Boston, who led the study, said
women should be aware that breast conserving surgery can come
with a long follow-up.
"We're not suggesting that women have a mastectomy instead,"
"The good news is that the majority of these women will not
have a (cancer) recurrence. But the work-ups for a possible
recurrence are likely to continue for years."
The findings fit into the bigger issue of the pros and cons
of mammography screening. 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 from
Since mammograms came into widespread use in the 1980s, the
number of DCIS diagnoses has shot up. 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 currently there is no way to
predict which cases will progress.
So women with DCIS almost always receive treatment, which
for some may be unnecessary.
When it comes to early prostate cancer, which is also
usually caught through screening, men have the option to delay
treatment and choose "active surveillance" - where the cancer is
monitored to see if it's progressing.
That's because prostate cancer is frequently slow-growing
and may never threaten a man's life.
But this is not an option for DCIS yet since there's no way
of telling which tumors might progress quickly, although it
could become one if researchers find certain tumor
characteristics that strongly predict it's benign, Fenton said.
This will also probably take a "cultural shift," Nekhlyudov
noted, since people typically want aggressive treatment for
cancer, even if it's early stage.
(Reporting from New York by Amy Norton at Reuters Health;
editing by Elaine Lies and Bob Tourtellotte)