Pre-Malignant Breast Lesions, Methods of Treatment and Outcome
This retrospective study includes 60 patients with pre-invasive breast cancer. Aim of the study: Evaluation of premalignant lesions of the breast (DCIS), different treatment methods and outcome. Patients and methods: 60 patients with DCIS were studied from the period between 2005 to 2012, for 38 patients the primary surgical method was wide local resection (WLE) (63.3%) and the other cases (22 patients, 36.7%) had mastectomy, fourteen cases from those who underwent local excision received radiotherapy, while no adjuvant radiotherapy was given for those who underwent mastectomy. In case of hormonal receptor positive DCIS lesions hormonal treatment (Tamoxifen) was given after local control. Results: No difference in overall survival between mastectomy & breast conserving therapy (wide local excision and adjuvant radiotherapy), however local recurrence rate is higher in case of breast conserving therapy, also no role of Axillary evacuation in case of DCIS. The use of hormonal therapy decreases the incidence of local recurrence by about 98%. Conclusion: The main management of DCIS is local treatment (wide local excision and radiotherapy) with hormonal treatment in case of hormone receptor positive lesions.
[1] Harris JR, Lippman ME, Veronesi U, Willett W. Breast cancer (second of three parts). New England Journal of Medicine 1992;327(6):390–8.
[2] Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM. Ductal carcinoma in situ of the breast.New England Journal of Medicine 2004;350:1430–41.
[3] Levine M. Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: the management of ductal carcinoma in situ (summary of the 2001 update). Canadian Medical Association Journal 2001;165(7):912–3.
[4] Fisher B, Dignam J, Wolmark N, Mamounas E, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J ClinOncol 1998; 16: 441–452.
[5] Julien J-P, Bijker N, Fentiman IS, et al. Radiotherapy in breast conserving treatment for ductal carcinoma in situ: first result of EORTC randomized phase III trial 10853. Lancet 2000; 355: 528–533.
[6] Amichetti M, Caffo O, Richetti A, et al. Ten year results of treatment of ductal carcinoma in situ (DCIS) of the breast with conservative surgery and radiotherapy. Eur J Cancer 1997; 33: 1559–1565.
[7] Fisher B, Land S, Mamounas E, 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. SeminOncol 2001;28: 400–418.
[8] Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010; 102:170.
[9] Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212-236.
[10] Intra M, Veronesi P, Mazzarol G, et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 2003; 138:309-313.
[11] Silverstein MJ, Lagios MD. Should all patients undergoing breast conserving therapy for DCIS receive radiation therapy? No. One size does not fit all: an argument against the routine use of radiation therapy for all patients with ductal carcinoma in situ of the breast who elect breast conservation. J SurgOncol 2007; 95:605-609.
[12] Bijker N, Meijnen P, Peterse JL, et al. Breast conserving treatment with or without radiotherapy in ductal carcinoma insitu: ten year results of European organization for research and treatment of cancer randomized phase 3 trial 10853 a study by the EORTC breast cooperative Group and EORTC radiotherapy Group. J ClinOnco. Jul 20 2006;24(21):3381-3387.
[13] Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011; 103:478.
[14] Claus EB, Chu P, Howe CL, et al. Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. ExpMolPathol 2001; 70:303-316. [15] Selim AG, El-Ayat G, Wells CA. Androgen receptor expression in ductal carcinoma in situ of the breast: relation to oestrogen and progesterone receptors. J ClinPathol 2002; 55:14-16.
[16] Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ. Eur J Cancer 2005;41:1715-23.
[17] Vargas C, Kestin I, Go N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys. 2005 Dec 1;63:1514-21.
[18] Meijnen, Oldenburg &Peterse , Bartelink H, Rutgers EJ, Ann Surg Oncol. 2008 Jan;15(1):235-43. Epub 2007 Nov 7
[19] Wang SY, Chu H, Shamliyan T, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst 2012; 104:507-516.
[1] Harris JR, Lippman ME, Veronesi U, Willett W. Breast cancer (second of three parts). New England Journal of Medicine 1992;327(6):390–8.
[2] Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM. Ductal carcinoma in situ of the breast.New England Journal of Medicine 2004;350:1430–41.
[3] Levine M. Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: the management of ductal carcinoma in situ (summary of the 2001 update). Canadian Medical Association Journal 2001;165(7):912–3.
[4] Fisher B, Dignam J, Wolmark N, Mamounas E, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J ClinOncol 1998; 16: 441–452.
[5] Julien J-P, Bijker N, Fentiman IS, et al. Radiotherapy in breast conserving treatment for ductal carcinoma in situ: first result of EORTC randomized phase III trial 10853. Lancet 2000; 355: 528–533.
[6] Amichetti M, Caffo O, Richetti A, et al. Ten year results of treatment of ductal carcinoma in situ (DCIS) of the breast with conservative surgery and radiotherapy. Eur J Cancer 1997; 33: 1559–1565.
[7] Fisher B, Land S, Mamounas E, 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. SeminOncol 2001;28: 400–418.
[8] Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010; 102:170.
[9] Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212-236.
[10] Intra M, Veronesi P, Mazzarol G, et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 2003; 138:309-313.
[11] Silverstein MJ, Lagios MD. Should all patients undergoing breast conserving therapy for DCIS receive radiation therapy? No. One size does not fit all: an argument against the routine use of radiation therapy for all patients with ductal carcinoma in situ of the breast who elect breast conservation. J SurgOncol 2007; 95:605-609.
[12] Bijker N, Meijnen P, Peterse JL, et al. Breast conserving treatment with or without radiotherapy in ductal carcinoma insitu: ten year results of European organization for research and treatment of cancer randomized phase 3 trial 10853 a study by the EORTC breast cooperative Group and EORTC radiotherapy Group. J ClinOnco. Jul 20 2006;24(21):3381-3387.
[13] Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011; 103:478.
[14] Claus EB, Chu P, Howe CL, et al. Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. ExpMolPathol 2001; 70:303-316. [15] Selim AG, El-Ayat G, Wells CA. Androgen receptor expression in ductal carcinoma in situ of the breast: relation to oestrogen and progesterone receptors. J ClinPathol 2002; 55:14-16.
[16] Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ. Eur J Cancer 2005;41:1715-23.
[17] Vargas C, Kestin I, Go N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys. 2005 Dec 1;63:1514-21.
[18] Meijnen, Oldenburg &Peterse , Bartelink H, Rutgers EJ, Ann Surg Oncol. 2008 Jan;15(1):235-43. Epub 2007 Nov 7
[19] Wang SY, Chu H, Shamliyan T, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst 2012; 104:507-516.
@article{"International Journal of Medical, Medicine and Health Sciences:73226", author = "Ahmed Mostafa and Mohamed Mahmoud and Nesreen H. Hafez and Mohamed Fahim", title = "Pre-Malignant Breast Lesions, Methods of Treatment and Outcome", abstract = "This retrospective study includes 60 patients with pre-invasive breast cancer. Aim of the study: Evaluation of premalignant lesions of the breast (DCIS), different treatment methods and outcome. Patients and methods: 60 patients with DCIS were studied from the period between 2005 to 2012, for 38 patients the primary surgical method was wide local resection (WLE) (63.3%) and the other cases (22 patients, 36.7%) had mastectomy, fourteen cases from those who underwent local excision received radiotherapy, while no adjuvant radiotherapy was given for those who underwent mastectomy. In case of hormonal receptor positive DCIS lesions hormonal treatment (Tamoxifen) was given after local control. Results: No difference in overall survival between mastectomy & breast conserving therapy (wide local excision and adjuvant radiotherapy), however local recurrence rate is higher in case of breast conserving therapy, also no role of Axillary evacuation in case of DCIS. The use of hormonal therapy decreases the incidence of local recurrence by about 98%. Conclusion: The main management of DCIS is local treatment (wide local excision and radiotherapy) with hormonal treatment in case of hormone receptor positive lesions.
", keywords = "Ductal carcinoma in situ, surgical treatment, radiotherapy, breast conserving therapy, hormonal treatment.", volume = "10", number = "7", pages = "360-4", }
