Aggressive local treatment for screen-detected DCIS results in very low rates of recurrence

Aims: To review our institution's practice of treatment of a mammographical ly detected population of ductal carcinoma in situ (DCIS) patients and to d etermine the outcome. Methods: Between April 1989 and March 1994, 304 women with median age 59 ye ars (range 51-65) with DCIS detected on screening mammogram, were treated i n the Newcastle General and Royal Victoria Infirmary Hospitals, Newcastle-u pon-Tyne, UK. More than half of the women (n = 176, 57.8%) decided to have mastectomy. Other treatment options were wide local excision (WLE) with rad iotherapy (n = 97, 32%) and WLE alone (n = 31, 10.2%). All except five rece ived adjuvant hormone treatment. Results: Predominant DCIS was comedo in 122 (42%), followed by cribriform i n 87 (30%) and micropapillary in 44 (15%) cases. Grade I was found to be co mmonest grade (54%) followed by grade 11 (27%) and grade III (11%). With a median follow-up of 88 months, there were six (2%) recurrences, all of whic h were in women who were given breast conservation treatment, WLE with radi otherapy (n = 1, 1%) and without radiotherapy (n = 5, 16.6%). Mastectomy in this series was not associated with any recurrence at all. In three cases the recurrence was invasive, one of who also had distant metastasis. Conclusions: The findings of this study suggest that in women with DCIS sui table for breast conservation, WLE when combined with radiotherapy is assoc iated with a very low recurrence rate. (C) 2001 Harcourt Publishers Ltd.