Surgery May Be Overused for Low-Grade DCIS
(HealthDay News) — Surgery for low-grade ductal carcinoma in situ (DCIS) does not significantly improve outcomes for patients, according to research that raises questions about the overuse of surgery for the condition. The study was published online June 3 in JAMA Surgery.
Investigators examined data on 57,222 cases of DCIS. The study was led by Yasuaki Sagara, MD, a surgeon at Brigham and Women's Hospital and the Dana-Farber/Brigham and Women's Cancer Center in Boston.
The team found that for women with low-grade DCIS, the 10-year survival rate was 98.8% for those who had surgery at the time of diagnosis or shortly after, and 98.6% for those who did not have surgery (P=0.95). However, for women with intermediate- or high-grade DCIS, the weighted hazard ratios did differ significantly (intermediate grade: hazard ratio, 0.23; 95% confidence interval, 0.14–0.42; and high grade: hazard ratio, 0.15; 95% confidence interval, 0.11–0.23), with similar results seen for overall survival.
In a Brigham and Women's Hospital news release, senior author Mehra Golshan, MD, said he believes that "we are overtreating breast cancer in the United States, and this study, along with others, suggests the need for treatment strategies tailored to a woman's specific cancer, not just breast cancer in general." Golshan is director of Breast Surgical Services at Dana-Farber/Brigham and Women's Cancer Center. "This study alone does not allow us to definitively conclude that breast surgery should be avoided for women with low-grade DCIS," Sagara added in the news release. However, "we believe that a prospective clinical trial – following patients over time from diagnosis through treatment and beyond – is warranted," he said.