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You are here: Home: BCU 4|2002: Program Supplement: Case 2
Miami Breast Cancer
Conference
Tumor Board Case 2: Frank Vicini, MD
A young woman with DCIS |
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| The patient is a 45-year-old premenopausal
woman with a 3 cm, grade 3 DCIS, which was excised with
clear but very close margins (less than 1 mm). She has
small breasts but wants breast conservation and is very
concerned about cosmesis. What is your recommendation
for local therapy?
She undergoes further excision and no more tumor is
found.
How would you approach the axilla?
She undergoes a sentinel lymph node biopsy, which is
negative.
Which systemic therapy would you recommend?
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For the initial presentation, most of the respondents recommended
radiation therapy without further surgery. This is consistent with
data from the NSABP suggesting that as long as margins are clear,
no further surgery is needed. Dr Vicini’s patient was sent
for further surgery, primarily because of her young age. Most respondents
would not use axillary staging in this patient, but this woman had
a negative sentinel node biopsy. Most of the respondents recommended
tamoxifen, which is what the patient received.
Fisher B et al. Prevention of invasive breast cancer in women
with ductal carcinoma in situ: An update of the national surgical
adjuvant breast and bowel project experience. Semin Oncol
2001;28(4):400-18. Abstract
Skinner KA, Silverstein MJ. The management of ductal carcinoma
in situ of the breast. Endocr Relat Cancer 2001;8(1):33-45.
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