Sept. 26, 2008 – It is widely believed that young women with a common form of early breast cancer have a worse prognosis than older women, but new research suggests that this isn’t so.
Local recurrence rates 15 years after treatment were just 10% for women treated at age 40 or younger -- about the same as women who were in their mid to late 50s and 60 when treated.
The findings show that with aggressive treatment, even very young women with DCIS do very well with breast-conserving surgery, says lead researcher Aruna Turaka, MD, of Philadelphia’s Fox Chase Cancer Center.
Turaka presented the findings this week at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology in Boston.
“This was a lower recurrence rate than is generally reported, and we saw no significant difference in recurrences based on age,” she tells WebMD. “Our experience suggests that with the right treatment, young age may play a smaller role in recurrence than has been thought.”
DCIS in Young Women
In DCIS, cancer is confined to the milk ducts and has not yet spread to the surrounding tissue of the breast.
The very early cancer is usually treated with breast-conserving surgery, known as lumpectomy, followed by whole-breast radiation.
At Fox Chase Cancer Center, surgeons commonly operate more than once to ensure that the breast is free of cancer and radiologists give an additional "boost" of targeted radiation at the site of the removed tumor. Some patients also take the drug tamoxifen as an adjunct to treatment.
In an effort to determine if these practices lead to better outcomes, Turaka reviewed the medical records of 440 patients with DCIS treated at the cancer center between 1978 and 2007, including 24 patients who were aged 40 or younger when they were treated.
Following initial surgery, tumors were examined for evidence of cancer around the sides, or margins, of the removed tissue. If cancer cells were seen by pathologists, surgeons would take more tissue until tumor margins were free of cancer.
Three out of four (75%) of the patients who were aged 40 or younger had this additional surgery, known as surgical re-excision, compared to 62% of all patients.
All the women also received five weeks of whole-breast radiation, and 95% also received the radiation boost at the site of the removed tumor.
The average follow up was 6.8 years (range 0.2 to 24 years) and the average age of the patients at treatment was 56.
Overall, the local recurrence rate was 7% at 10 years and 8% at 15 years.
DCIS recurrence rates did not vary by age, tumor margin status after lumpectomy, or whether or not the patients took tamoxifen.
Turaka credits the low recurrence rate to careful patient selection, the use of surgical re-excision, and the radiation boost.
Expert: More Study Needed
Radiation oncologist Jennifer F. De Los Santos, MD, says careful surgical follow up and the radiation boost may negate the increased risk associated with young age in patients with DCIS.
But she adds that the number of young DCIS patients in the study was far too small to conclude that young patients have the same prognosis with aggressive treatment as older women.
“This was not a randomized study and there were only 24 patients who were 40 years old and younger,” she tells WebMD. “While the findings are provocative they are in no way conclusive because of these two things.”
De Los Santos says a larger, randomized study is under way that should help clarify the role of boost radiotherapy in the treatment of DCIS patients.
Debbie Saslow, PhD, of the American Cancer Society, says studies like this show the importance of treating DCIS aggressively.
“Some people say that we are over-treating DCIS, and it is true that some women may be getting more aggressive treatment than they really need,” she tells WebMD. “We’ve been saying all along that you have to treat DCIS, because if you don’t do anything a lot of women will end up with invasive cancer.”