Study Suggests Excision and Surveillance Alone Successfully Treat Noninvasive Breast Cancer

A new study of women with locally advanced, in situ (noninvasive) ductal breast cancer reveals that excision and surveillance alone are a treatment alternative to mastectomy or irradiation. Results of the study were presented at the 32nd Annual Meeting of the American Society of Clinical Oncology in Philadelphia on May 21.

The data, collected between 1975 and 1994, at Jefferson Medical College, shows that only 28 of 194 breasts (three women had bilateral in situ cancer) treated with excision and surveillance alone had a recurrence. There was a mean and median follow-up of 55 and 53 months, respectively.

During that time, only five of the 194 breasts in 191 women, or 3 percent of the recurrences showed evidence of invasive (or life-threatening) cancer, including microinvasion. Twenty-three recurrences were entirely noninvasive.

According to senior author and presenter Gordon F. Schwartz, MD, MBA, professor of surgery and a specialist in diseases of the breast, these findings are contrary to those in most other studies to date. "No patient in this group has died from breast cancer since the study began," he explains. "Even if recurrence does take place, it is most likely to be the same type of noninvasive cells as the first time. And in selected cases, a second, local excision may be suitable instead of irradiation or mastectomy."

Women with a confirmed diagnosis of noninvasive breast cancer underwent post-biopsy mammography to verify excision of calcifications.

Wide, local re-excision was performed in most patients. The maximum diameter of calcifications considered suitable for this treatment option was 2.5 cm.

"Excision and surveillance is a reasonable alternative to mastectomy or irradiation for selected women with localized (in situ ductal) breast cancer that presents nonpalpable calcifications, or as an incidental finding," says Dr. Schwartz. "A major treatment recommendation such as radiation or mastectomy may be withheld until and if a recurrence does take place."

Dr. Schwartz notes, however, that even if a recurrence does occur, it is likely to be noninvasive.