When a woman receives the dreaded diagnosis of breast cancer, disfiguring surgery—a mastectomy or a less extensive lumpectomy—comes to mind. A new study has reported that surgery may be overtreatment for some women with low-grade ductal carcinoma of the breast. They suggested that the alternative of active surveillance (close monitoring) may be appropriate. The findings were published online on December 23 in the journal JAMA Oncology by British researchers.
The study authors note that the prevalence of ductal carcinoma in situ of the breast has increased significantly since the introduction of breast-screening methods; however, the clinical significance of early detection and treatment for ductal carcinoma in situ remains unclear. Therefore, they conducted a study to assess the survival benefit of breast surgery for low-grade ductal carcinoma in situ.
For the study, the researchers accessed data from the Surveillance, Epidemiology, and End Results (SEER) database from October 9, 2014 through January 15, 2015 at the Dana-Farber/Brigham Women’s Cancer Center. From 1988 to 2011, 57,222 eligible cases of ductal carcinoma in situ were identified. The patients were divided into surgery and non-surgery groups.
The investigators found that, of 57,222 cases of ductal carcinoma in situ identified, 1,169 cases (2.0%) were managed without surgery and 56,053 cases (98.0%) were managed with surgery. During an average follow-up of 72 months from diagnosis, there were 576 breast cancer–specific deaths (1.0%). The 10-year breast cancer–specific survival was 93.4% for the non-surgery group and 98.5% for the surgery group. The degree of survival benefit among the women managed surgically differed according to the cancer grade. For low-grade ductal carcinoma in situ, the 10-year breast cancer–specific survival of the non-surgery group was 98.8% and that of the surgery group was 98.6%. Statistical analysis revealed that there was no significant difference in the cancer–specific survival between the surgery and non-surgery groups for low-grade ductal carcinoma in situ. The impact on survival for intermediate- and high-grade ductal carcinoma in situs were significantly different (low grade: 15%; intermediate grade: 77%; and high grade: 85%); similar results were seen for overall survival.
The authors concluded that the survival benefit of undergoing breast surgery for low-grade ductal carcinoma in situ was lower than that for intermediate- or high-grade ductal carcinoma in situ. They recommended that a prospective (forward-looking) clinical trial should be conducted to investigate the feasibility of active surveillance for the management of low-grade ductal carcinoma in situ.
The researchers are affiliated with: Sussex Health Outcomes, Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom; and Department of Breast Surgery, Nuffield House, Queen Elizabeth Hospital, Queen, Elizabeth Medical Centre, Birmingham, United Kingdom