International Breast Cancer Specialists’ Group Agrees on Options for Controversial Early Stage Cancer Treatment 

For the second time in three years, three medical journals will concurrently publish the findings of 35 breast cancer specialists from around the world.

A who’s who of breast cancer experts from medical institutions around the world have agreed upon a series of treatment options for Ductal Carcinoma In Situ (DCIS), a controversial malignancy found in the breast, as an important new step toward improving patient treatment for this type of early breast cancer. DCIS currently represents 25 to 30 percent of all breast cancers diagnosed. 

In a paper to be published concurrently by three medical journals, Cancer, Human Pathology and The Breast Journal, the international Consensus Conference Committee outlines treatment options for DCIS to help determine the appropriate treatment for each patient.
The consensus conference was hosted and chaired by Gordon F. Schwartz, MD, MBA, Professor of Surgery, Jefferson Medical College (JMC).

“Now when DCIS is encountered, whether it’s in Philadelphia, London or in Timbuktu, there can be a set of treatment options available,” said Dr. Schwartz. “This should set the standard for treating DCIS.”

The committee made its recommendations during a weekend-long conference held April 22-25, 1999 in Philadelphia. This is the second time in three years these specialists have met to examine DCIS. The Breast Health Institute and the Fashion Group International – Philadelphia, supported the conference.

In 1997, the international conclave created a classification system for DCIS – an important first step toward improving patient treatment of this early-stage breast cancer. 

As a result of the 1999 meeting, the group agreed that, when possible, women with DCIS should be treated with breast conservation through lumpectomy or lumpectomy along with radiation therapy. Mastectomy may still be regarded as a treatment option for some women with DCIS.

However, each patient along with her physician must determine the most appropriate means, the group indicated. The group also concurred that there is no evidence yet that the use of tamoxifen in conjunction with any of these options will have a survival benefit in DCIS patients, Dr. Schwartz said.

“It was the opinion of the committee that the role of tamoxifen in patients undergoing breast conservation for DCIS is promising, but is still under investigation,” the Jefferson breast specialist said.

One panelist, Roland Schwarting, MD, Associate Professor of Pathology, Anatomy and Cell Biology, and Director of Immunopathology, Hematopathology, and Molecular Diagnostics, JMC, presented his own experience in using biologic markers as predictors of local recurrence following breast conservation for DCIS. Dr. Schwartz noted that Jefferson is in the forefront in the use of biologic markers to help decide treatment.

The report’s significance in determining treatment options for DCIS is confirmed by the fact that three journals have agreed to publish the paper at the same time, Dr. Schwartz said. The 1997 report was also published concurrently by the same journals. 

“It’s rarely done,” said Dr. Schwartz of the multiple journal publications, “By chance, not by design, three of the physicians who were here are also the editors-in-chief of the three journals. They thought it was important enough to reach all three journal audiences.”
DCIS can be described as looking like a cluster of salt granules on a mammogram. Although a majority of patients with DCIS will not develop a more threatening cancer, in some patients the DCIS can progress to become an invasive, life-threatening malignancy, Dr. Schwartz said. As a result, the treatment of DCIS has ranged from mastectomy to a combination of lumpectomy and radiation treatment to lumpectomy alone, depending on the physician’s judgement. In the late 1970s, mastectomy was the standard treatment for DCIS, Dr. Schwartz noted.

The committee members include pathologists, surgeons, radiation and surgical oncologists and biostatisticians, from medical institutions around the globe. 

For a complete commitee member list, and information on sponsors, please see below:

Biostatistician:

•Dr. Carol Bodian
The Mount Sinai Medical Center, New York, N.Y. 

Epidemiologist:

•Dr. Virginia Ernster
University of California School of Medicine
San Francisco, Calif.

Medical Oncologist

•Bruce M. Boman, MD, PhD
Director, Division of Medical Oncology and Medical Genetics,
Thomas Jefferson University Hospital, Philadelphia

Pathologists:

•Dr. Gerald Finkel Jefferson Medical College, Philadelphia, Pa	•Dr. Fred Gorstein The Jacob and Sophie Rubin Professor and vice chairman of the Department of Pathology, Anatomy and Cell Biology, Jefferson Medical College, Philadelphia.	•Dr. Roland Holland Academisch Ziekenhus Nijmegen Nijmegen, The Netherlands
•Dr. Robert V.P. Hutter Saint Barnabas Medical Center, Livingston, N.J.	•Dr. Michael Lagios St. Mary’s Medical Center, San Francisco, Calif.	•Dr. Shahla Masood University of Florida Health Science Center, Jacksonville, Fla.
•Dr. Juan Palazzo Jefferson Medical College, Philadelphia	•Dr. Roland Schwarting Jefferson Medical College, Philadelphia.

Radiation Oncologists:

•Dr. Alain Fourquet Institut Curie, Paris, France	•Dr. Bruce G. Haffty Yale University School of Medicine, New Haven, Conn.	•Dr. Lydia Komarnicky. Jefferson Medical College, Philadelphia
•Dr. Beryl McCormick Memorial Sloan-Kettering Cancer Center, New York, N.Y.	•Dr. Ivo A. Olivotto BC Cancer Agency, Vancouver, British Columbia	•Dr. Lawrence J. Solin Hospital of the University of Pennsylvania

Radiologists:

•Dr. R. James Brenner Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, Santa, Monica, Calif.	•Dr. Catherine Piccoli Director, Breast Imaging Center,  Thomas Jefferson University Hospital, Philadelphia	•Dr. Stephen A. Feig, Jefferson Medical College, Philadelphia, Pa.
•Dr. Daniel B. Kopans Massachusetts General Hospital, Boston, Mass.

Surgical Oncologists:

•Professor R.W. Blarney City Hospital, NHS Trust, Nottingham, UK	•Dr. Nigel Bundred South Manchester University Hospital Manchester, UK	•Professor Luigi Cataliotti, Instituto Di Clinica Chirugica Generale eTerapia Chirugica I, Florence, Italy
•J. Michael Dixon Edinburgh Breast Unit, Western General Hospital Edinburgh, Scotland	•Professor Ian S. Fentiman Guy’s Hospital, London, UK	•Dr. David W. Kinne Columbia-Presbyterian Medical Center, New York City
•Dr. Richard Margolese Jewish General Hospital, Montreal, Quebec	•Dr. George N. Peters UT Southwestern Center for Breast Care, Dallas, Tx.	•Dr. Peter I. Pressman Albert Einstein School of Medicine, New York City
•Dr. Bruno Salvadori Insituto Nazionale Tumori, Milan, Italy	• Dr. Emiel J. Th. Rutgers The Netherlands Cancer Institute, Amsterdam, The Netherlands	•Dr. Gordon Schwartz (conference chairman) Jefferson Medical College, Philadelphia, Pa.
•Dr. Daniela Terribile Universita Cattollica S. Cuore, Rome Italy	•Dr. Melvin Silverstein USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, Calif.

The conference was funded through the annual “Give the Shirt Off Your Back! Fight Breast Cancer” gala dinner dance sponsored by the Breast Health Institute and the Fashion Group International-Philadelphia.

The Breast Health Institute (BHI) was founded in response to an ever-increasing incidence of breast cancer and a corresponding decrease in the availability of public funds for basic and clinical research in this specialty. BHI is a non-profit organization dedicated to raising funds for clincal research, education and public awareness of breast cancer. BHI funds many early detection programs for the underserved women of the Delaware Valley.

Fashion Group International (FGI) is a nonprofit association promoting the advancement of professionals in the fashion industry. Members include professionals in design, marketing, manufacturing, retailing, advertising and publishing, and those who provide research, financial and educational services to the fashion industry. FGI members create events nationwide and join with other organizations to support causes that benefit entire communities.

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