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Some Breast Cancer Recurrence Associated With Younger Age

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WebMD Health News

Jan. 14, 2000 (Cleveland) -- Lumpectomy, a surgical procedure in which cancerous tissue is removed from the breast but the breast is left intact, is the recommended surgery for women with ductal carcinoma in situ (DCIS), a type of cancer that has a cure rate approaching 100%. But in some women DCIS recurs following surgery, and now a researcher from Michigan is suggesting that recurrence is more likely in younger women than older women.

The researcher, Frank Vicini, MD, a clinical associate professor of radiation oncology at William Beaumont Hospital in Royal Oak, Michigan, says his study of medical records from 146 women treated with lumpectomy suggests that surgeons may not remove enough tissue from the breasts of these women. One reason, Vicini tells WebMD, may be "a cosmetic concern, hoping to preserve a good appearance." He says that the study, reported in the January issue of the Journal of Clinical Oncology, shows that regardless of age, women who had large excisions (meaning that the surgeon removed a good border of healthy tissue around the cancerous tissue) "were unlikely to have recurrences."

Vicini adds, however, that his study includes women who had their lumpectomy surgery done 20 years ago when surgeons and radiation oncologists weren't so careful about the so-called margin around the lump. He says it is "doubtful that this would be a problem for any women whose surgery was in the last 10 years." Vicini says that this past decade "surgeons and radiation oncologists have determined the necessity of good, clear margins." Although he says that margins "should probably be at least 3 to 5 mm, it is difficult to state a firm margin because another issue is the volume of cancer close to the margin." The location of the bulk of the cancer and its relationship to the outside edge of the removed tissue is a concern in many skin cancers, and Vicini says he thinks the same factor is an issue with DCIS.

Vicini also says that he wants to reassure women who have had lumpectomy for DCIS that there is no threat to their survival. "Although younger women had a higher recurrence rate -- 26.1% compared to 8.6% -- the salvage rate is still the same; still more than 99% of women are cured."

Lawrence Levy, MD, a breast surgeon at the Cleveland Clinic Foundation's breast center, says Vicini's study is "by its very nature, not very statistically sound because it is a retrospective study of 146 women, which is a pretty small group of people to look at. ... You can't really determine if the conclusions are valid or not."

Levy says that there is a great deal of interest in the breast surgery community in markers that might "predict the likelihood of recurrence. It will become even more important to find these indicators -- if any can be found -- as mammography improves and we are presented with smaller and smaller lesions."

Vital Information:

  • Ductal carcinoma in situ (DCIS) is a type of breast cancer with a cure rate close to 100%.
  • A recent study shows that younger women with DCIS who undergo lumpectomy are more likely to have recurrence, compared with older women.
  • Surgeons should be sure to remove a good border of healthy tissue to lower the chances of recurrence, according to one study.

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