Some Breast Cancer Recurrence Associated With Younger Age
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
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
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
- 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.