DCIS breast cancer: radiotherapy can reduce recurrence risk
25 July 2003
New recommendations on the clinical management of ductal carcinoma in situ (DCIS) of the breast will emphasise the value of radiotherapy after initial surgical excision, the National Breast Cancer Centre (NBCC) says.
(Ductal carcinoma in situ (DCIS) is a cancer inside the ducts of the breast that has not grown through the wall of the duct into the surrounding breast tissues. It is sometimes referred to as a precancer, and is detected increasingly as a consequence of mammogram screening programmes.)
The advice followed several large international studies demonstrating that radiotherapy reduced the risk of recurrent DCIS and invasive cancer after surgery, said leading breast surgeon Professor Colin Furnival, chair of the NBCC working party on DCIS.
The latest study of nearly 1700 women in Australia, New Zealand and the UK showed that the rate of DCIS recurrence was lower in patients who received radiotherapy, compared with those who did not, with radiotherapy associated with an 8.9 per cent reduction in absolute risk (Lancet 2003; 362: 95-102).
The randomised trial was designed to assess the benefits of radiotherapy, tamoxifen (an anti-oestrogen medication currently used to treat breast cancer) or both following complete surgical excision of DCIS.
Tamoxifen reduced the relative risk of DCIS recurrence by 26 per cent but did not significantly reduce the rate of invasive cancer or events overall, leading the authors to conclude that 'there is little evidence for the use of tamoxifen in these women'.
Professor Furnival, from the Wesley Medical Centre in Brisbane, said the study strengthened the evidence for current practice in Australia to treat with radiotherapy after removal of high-grade DCIS.
Last Reviewed: 25 July 2003
- 1. Medical Observer Weekly 25/7/03
