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Home: Oncology Leader Commentary: Richard Margolese, MD

Click on the topic below for comments by Dr Richard Margolese to comment on. You will also find links to related articles and clinical trials.

Surgery and breast cancer
Philosophy of DCIS management
Excision alone for DCIS
DCIS subsets
Margins and DCIS
Is DCIS a surgical disease?
Tamoxifen for DCIS
NSABP DCIS trials
Tamoxifen: Prevention or delay of clinical onset of disease
Risk-benefits of tamoxifen for DCIS
Tamoxifen and venous thrombosis
Duration of preventive effect of tamoxifen
Mortality effects of tamoxifen in high-risk women
Raloxifene as chemoprevention

Margins and DCIS

Interview with Neil Love, MD from Breast Cancer Update for Surgeons, Program 1 2000

Play Audio Below:

Margins is a terribly difficult topic to deal with, there’s a lot of emotion attached to margins. And the controversy would imply that NSABP surgeons go to the operating room and attempt to get shaving thin margins and, of course, they don’t. NSABP surgeons try to get reasonably good margins just like everyone else does, and we try to get about a centimeter. But in a disease that you can feel the tumor, like invasive cancer, it’s a little bit easier to define the scope of surgery and get a margin. Where you’re dealing with micro-calcifications it’s difficult to get margins, especially because the disease tends to extend along ducts, and even putting extra needles in to mark the edges of the calcification may not always give you microscopically free margins or microscopically wide margins. In the NSABP series we accepted a free margin as being free without any definition of size so some are less than a millimeter, but they’re not all less than a millimeter. And the point is that the statistics we publish are achieved with that definition of margins. Therefore, I’m comfortable in looking at these and saying that "a clear margin is a clear margin".

Relevant Articles:

The incidence of positive margins with breast conserving therapy following mammotome biopsy for microcalcification
Cangiarella, J.; Cross, J.; Symmans, W. F.; Waisman, J.; Petersen, B.; D'Angelo, D.; Singer, C., and Axelrod, D.. Journal of Surgical Oncology. 74(4):263-266, 2000 Aug.

Outcomes and factors impacting local recurrence of ductal carcinoma in situ.
Weng, E. Y.; Juillard, G. J. F.; Parker, R. G.; Chang, H. R., and Gornbein, J. A. Cancer. 88(7):1643-1649, 2000 Apr 1.

Risk of subsequent invasive breast cancer after breast carcinoma in situ
Warnberg, F.; Yuen, J., and Holmberg, L. (Reprint available from: Warnberg F Univ Uppsala Hosp, Dept Surg S-75185 Uppsala Sweden).. Lancet. 355(9205):724-725, 2000 Feb 26.

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.

Sentinel node biopsy in ductal carcinoma in situ patients.
Pendas, S.; Dauway, E.; Giuliano, R.; Ku, N. N.; Cox, C. E., and Reintgen, D. S.. Annals of Surgical Oncology. 7(1):15-20, 2000 Jan-Feb.

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

Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853.
Julien, J. P.; Bijker, N.; Fentiman, I. S.; Peterse, J. L.; Delledonne, V.; Rouanet, P.; Avril, A.; Sylvester, R.; Mignolet, F.; Bartelink, H., and Van Dongen, J. A. Lancet. 355(9203):528-533, 2000 Feb 12.

Differences in the pathologic features of ductal carcinoma in situ of the breast based on patient age.
Goldstein, N. S.; Vicini, F. A.; Kestin, L. L., and Thomas, M.. Cancer. 88(11):2553-2560, 2000 Jun 1.

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

Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy.
Kestin, L. L.; Goldstein, N. S.; Lacerna, M. D.; Balasubramaniam, M.; Martinez, A. A.; Rebner, M.; Pettinga, J.; Frazier, R. C., and Vicini, F. A.. Cancer. 88(3):596-607, 2000 Feb 1.

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

Treatment selection in ductal carcinoma in situ.
Morrow, M. and Schnitt, S. J. (Reprint available from: Morrow M NW Mem Hosp, Lynn Sage Comprehens Breast Ctr 251 E Huron St,Galter 13-174 Chicago, IL 60611 USA).. Jama: Journal of the American Medical Association. 283(4):453-455, 2000 Jan 26. No abstract
FULL TEXT:

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

Relevant Clinical Trials:

Phase III Randomized Study of Tamoxifen With or Without Radiotherapy in Women With Ductal Carcinoma In Situ (DCIS) of the Breast

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