Interview
with Neil Love, MD from Breast Cancer Update for Surgeons,
Program 1 2000
Play
Audio Below:
I
agree that not every patient needs radiation therapy, but that doesn’t
mean that we should strive to treat this as a surgical disease without
radiation therapy. I think the majority of patients should have
radiation therapy, but Mike Lagios and others have shown that there
are identifiable people with small and non-aggressive lesions where
surgery alone will work. And even a trial like the NSABP B17 shows
you that, although the recurrence rates are high without radiation
therapy — in terms of our traditional values they’re 25%
invasive and non-invasive together — this means that 75% of
the people don’t recur. Now, 75% of the people is not enough
if you can do better, and that’s where radiation comes in.
The idea that you should have large margins means that you will
be doing larger operations with more deformity, and although people
show you in meetings and symposia the best pictures, it takes a
very honest person to show you a more average or worst picture of
outcomes with more aggressive surgery. There are people in whom
you would like to do radiation therapy, who may not be suitable.
They may have collagen disease, they may have had a burn to their
chest, they may have lung disease and don’t want to risk the
radiation even though the damage risk for lung disease is slight;
that doesn’t mean that they have to automatically turn to mastectomy.
They can have a lumpectomy, you can strive to get clear margins
and they may do very well without radiation therapy. Having said
all that, the evidence says that for most patients, if you add radiation
therapy to traditional lumpectomy for DCIS, you get recurrence rates
which are quite low. In terms of invasive cancer, they’re 4%
and if we add in tamoxifen then they’re only 2%. And what’s
the risk of dying if the risk of having cancer is 2%? Which percent
of those people will be cured? And what’s the risk of dying
of it, and figures tell us it’s the same as for total mastectomy.
Impact
of young age on outcome in patients with ductal carcinoma-in-situ
treated with breast-conserving therapy Vicini, F. A.; Kestin, L. L.; Goldstein, N. S.; Chen, P. Y.;
Pettinga, J.; Frazier, R. C., and Martinez, A. A.. Journal of Clinical
Oncology. 18(2):296-306, 2000 Jan.
Carcinoma
in situ of the breast: correlation of histopathology to immunohistochemical
markers and DNA ploidy. Ottesen,
G. L.; Christensen, I. J.; Larsen, J. K.; Larsen, J.; Baldetorp,
B.; Linden, T.; Hansen, B., and Andersen, J. (Reprint available
from: Ottesen GL Univ Copenhagen, Inst Forens Med, Dept Forens Pathol
Frederik Vs Vej 11,POB 2713 DK-2100 Copenhagen O Denmark).. Breast
Cancer Research & Treatment. 60(3):219-226, 2000 Apr In process
Application
of the Van Nuys prognostic index in a retrospective series of 367
ductal carcinomas in situ of the breast examinated by serial macroscopic
sectioning: Practical considerations. de
Mascarel, I.; Bonichon, F.; MacGrogan, G.; de Lara, C. T.; Avril,
A.; Picot, V.; Durand, M.; Mauriac, L.; Trojani, M., and Coindre,
J. M. Breast Cancer Research & Treatment. 61(2):151-159, 2000
May. In process
Postexcision
mammography is indicated after resection of ductal carcinoma-in-situ
of the breast. Waddell, B. E.; Stomper, P. C.; DeFazio, J. L.; Hurd, T. C.,
and Edge, S. B. Annals of Surgical Oncology. 7(9):665-668, 2000
Oct. In process
Ductal
carcinoma in situ of the breast: A surgeon's disease. Silverstein, M. J. (Reprint available from: Silverstein MJ Univ
So Calif, Kenneth Norris Jr Comprehens Canc Ctr 1441 Eastlake Ave,Room
7415 Los Angeles, CA 90033 USA). Annals of Surgical Oncology. 6(8):802-810,
1999 Dec. No abstract
Role
of specimen radiography in patients treated with skin-sparing mastectomy
for ductal carcinoma in situ of the breast. Rubio, I. T.; Mirza, N.; Sahin, A. A.; Whitman, G.; Kroll, S.
S.; Ames, F. C., and Singletary, S. E. Annals of Surgical Oncology.
7(7):544-548, 2000 Aug. In process
Carcinoma
in situ of the female breast. 10 year follow-up results of a prospective
nationwide study. Ottesen, G. L.; Graversen, H. P.; Blichert-Toft, M.; Christensen,
I. J., and Andersen, J. A. (Reprint available from: Ottesen GL Univ
Copenhagen, Inst Forens Med, Dept Forens Pathol Frederik Vs Vej
11,POB 2713 DK-2100 Copenhagen Denmark).. Breast Cancer Research
& Treatment. 62(3):197-210, 2000 Aug In process
Outcomes
and factors impacting local recurrence of ductal carcinoma in situ. Lagios, M. D. and Silverstein, M. J. (Reprint available from:
Lagios MD St Marys Med Ctr, Breast Canc Consultat Serv San Francisco,
CA 94143 USA).. Cancer. 89(11):2323-2324, 2000 Dec 1. In process
Sentinel
lymph node biopsy: Is it indicated in patients with high-risk ductal
carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Klauber-DeMore, N.; Tan, L. K.; Liberman, L.; Kaptain, S.; Fey,
J.; Borgen, P.; Heerdt, A.; Montgomery, L.; Paglia, M.; Petrek,
J. A.; Cody, H. S., and Van Zee, K. J. Annals of Surgical Oncology.
7(9):636-642, 2000 Oct. In process
Relation
of a recurrent intraductal carcinoma (ductal carcinoma in situ)
to the primary tumor Fisher, E. R. and Fisher, B. (Reprint available
from: Fisher B NSABP Sci Directors Off 4 Allegheny Ctr,Suite 602
Pittsburgh, PA 15212 USA).. Journal of the National Cancer Institute.
92(4):288-289, 2000 Feb 16. No abstract
