DCIS and radiation

For the greater part of a decade there has been controversy regarding DCIS (ductal carcinoma in situ).

DCIS is different from invasive breast cancer in that abnormal, precancerous cells form within the milk duct of the breast but do not spread to other parts of the breast. If treated, it is usually curable. However, if left untreated, it substantially increases a woman's chance of developing invasive breast cancer.

Generally, if you have to have breast cancer this is a good one to get. It is 98-99% curable.

And it is curable with both mastectomy or lumpectomy/radiation. In some cases it is curable without the radiation --just the lumpectomy.

And there lies the controversy.

There are two schools of thought when it comes to DCIS. Kinda like Notorious BIG. There is west coast and east coast ways of treating.

In general, the standard recommendation after lumpectomy is to proceed with radiation to reduce the chance of local recurrence. This is East Coast and shown to be effective in a randomized trial and in a new analysis by Goodwin (Goodwin A, et al. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database of Systematic Reviews 2009, Issue 1.)

Radiation works and with modern techniques is usually very well tolerated. Yes, there can be side effects. Again, most women do very well with the treatment.
We'll talk about side effects next time.

West Coast was born in Van Nuys CA and the father is Dr. Mel Silverstein. He is a surgical oncologist and founder of the Breast Center in Van Nuys and the Van Nuys Prognostic Index.

Mel and I worked together for five years in the late 90's. He is an excellent surgeon and prolific writer and has built a career on DCIS. His work is not randomized and is sometimes at odds with the East Coast philosophy.

Mel would like to eliminate (as much as possible) the use of radiation for DCIS. And he shown that certain subsets of patients do not need radiation if the lesion was small enough, slow growing enough, and widely excised. But again the work is retrospective and not always agreed upon around the country.

Bottom line?

If you have DCIS see a specialist in surgical oncology, a radiation oncologist, and get a second opinion. It never hurts.

Cuz West Coast and East Coast continue the fued till this day. And it can be confusing out there in the middle.