Article

Conservative management of intraductal carcinoma (DCIS) of the breast

  1. Edwin R. Fisher MD1,2,
  2. Rosemary Leeming MD1,6,
  3. Stewart Anderson PhD1,3,5,
  4. Carol Redmond ScD1,3,5,
  5. Bernard Fisher MD1,4,*

Article first published online: 20 JUL 2006

DOI: 10.1002/jso.2930470302

Issue

Journal of Surgical Oncology

Journal of Surgical Oncology

Volume 47, Issue 3, pages 139–147, July 1991

Additional Information

How to Cite

Fisher, E. R., Leeming, R., Anderson, S., Redmond, C. and Fisher, B. (1991), Conservative management of intraductal carcinoma (DCIS) of the breast. J. Surg. Oncol., 47: 139–147. doi: 10.1002/jso.2930470302

Author Information

  1. 1

    Headquarters National Surgical Adjuvant Breast and Bowel Projects (NSABP), Pittsburgh, Pennsylvania

  2. 2

    Institute of Pathology, Shadyside Hospital, Pittsburgh, Pennsylvania

  3. 3

    Department of Biostatistics, School of Public Health, Pittsburgh, Pennsylvania

  4. 4

    Department of Surgery, School of Medicine, Pittsburgh, Pennsylvania

  5. 5

    University of Pittsburgh, Pittsburgh, Pennsylvania

  6. 6

    Department of Surgery, Mount Sinai Hospital, Cleveland, Ohio

*Institute of Pathology, Shadyside Hospital, 5230 Centre Ave., Pittsburgh, PA 15232

Publication History

  1. Issue published online: 20 JUL 2006
  2. Article first published online: 20 JUL 2006
  3. Manuscript Accepted: 12 MAR 1991

Funded by

  • USPHS. Grant Number: NCI-U10-CA-120270
  • American Cancer Society. Grant Number: (ACS-RC-13)

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Keywords:

  • breast recurrence;
  • lumpectomy;
  • multicentricity;
  • comedo-necrosis;
  • breast irradiation

Abstract

Seventy-six patients with intraductal carcinoma (DCIS) of the breast have been observed for 83 months (range 50-141) following treatment by lumpectomy (L) only (21), L and breast irradiation (XRT) (27), or mastectomy (28). All represented examples of DCIS retrieved after pathologic examination of a much larger cohort of patients with stage I and II invasive breast cancer enrolled in NSABP protocol 6. Local breast recurrences were similar for women with DCIS and those from this cohort at a similar period of follow-up with invasive cancer treated by L only (43% vs. 39%) and L + XRT (7% vs. 10%). The presence of moderate/ marked comedonecrosis was suggestively related to local breast recurrence (P = .07). This latter was significantly reduced for patients receiving post L XRT (P = .01). All local breast recurrences in this study and 29 of 31 recorded by others occurred at or close to the site of extirpation of the index cancer minimizing multicentricity as a contraindication for the conservative surgical treatment of DCIS. Survival rates which were similar for patients with DCIS regardless of form of local treatment were better than that observed for negative node patients with invasive cancer enrolled in protocol 6. Thus, DCIS is a less, not more, ominous disease than invasive cancer. This and other features of its natural history indicate that it would be a contradiction to treat invasive cancer but not DCIS conservatively.

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