Presentation,
22nd annual San Antonio Breast Cancer Symposium
(Source:
Breast Cancer Update for Surgeons, Program 1 2000)
Play
Audio Below:
I
think we have to believe that the highest order of evidence is the
prospective randomized trial. And, so I am more inclined to believe
that radiation has a benefit for all patients, albeit the magnitude
differs. Secondly, I have a difficult time extrapolating Dr. Silverstein’s
data directly to my practice, because we do not process tissues
in the precise same way that they do. So, I can’t necessarily
say that my margins are the same. Having said all that, probably
the only patients in my practice who get treated with excision alone
are those patients who have very small – and by "very
small," I mean less than one centimeter of DCIS, and usually
substantially less than one centimeter of DCIS – which
has been widely excised, meaning it’s floating in the middle
of the specimen. I don’t have a magic margin number, because,
you know, we take all our specimens and smash them in cassettes,
so that the margins are artificially flattened on two sides anyway.
And usually they are older women. I have a disinclination, based
on the currently available data, to treat premenopausal women, unless
they have, like, one duct of incidental DCIS, without radiation,
and they usually are lesions of low grade. So, right now, I am very
conservative. I eagerly await the results of the upcoming RTOG study,
which will ask some different questions about margin width and tamoxifen
after excision alone, to answer that further.
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
