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Mastectomy, breast reconstruction may reduce total number of procedures needed, compared to breast-sparing operation

Wednesday, April 11, 2012

Many women hope to spare nearly all of their tissue when diagnosed with non-invasive breast disease. While plenty ultimately do, minimalist breast-conserving surgeries (BCSs) tend to be succeeded by multiple diagnostic or invasive follow-ups, compared to mastectomies with or without breast reconstruction.

That was the conclusion of a 10-year inquiry into the matter, conducted by researchers in California and Massachusetts. Appearing in the Journal of the National Cancer Institute, the final report noted that a BCS may entail many subsequent tests or surgeries, a fact that until now was unproven.

Researchers found that among women who had the most common precursor to breast cancer, ductal carcinoma in situ (DCIS), three-quarters of those who opted for a BCS ended up having at least one invasive surgery or diagnostic exam in the decade that followed.

This risk of extra procedures essentially negates one of the purposes of a BCS - namely, to avoid invasive operations or tests later on. The authors explained that women with DCIS should be informed about this trend prior to deciding on BCSs, mastectomies or breast reconstructions.

In an editorial in the same issue of the journal, researchers from the Universities of California and Washington agreed.

"Women who choose to preserve their breasts with breast-conserving surgery may be embarking on a more extended journey than anticipated," they explained. "Concerns about the substantial risk of subsequent invasive procedures may possibly sway more women to choose initial mastectomy over breast-conserving surgery."

That is not to say that mastectomy is the only appropriate option for women with DCIS. Rather, physicians simply need to inform patients of the risk of subsequent procedures so that they can weigh the benefits of having a mastectomy and breast reconstruction surgery against those of a BCS.

Sources:

Fiore K. Breast-Sparing Surgery Means More Procedures. MedPage Today. April 6, 2012. http://www.medpagetoday.com/HematologyOncology/BreastCancer/32071 Accessed April 9, 2012.

Nekhlyudov L. Ten-Year Risk of Diagnostic Mammograms and Invasive Breast Procedures After Breast-Conserving Surgery for DCIS. Journal of the National Cancer Institute. Published online ahead of print, April 2012. http://jnci.oxfordjournals.org/content/early/2012/04/05/jnci.djs167.abstract Accessed April 9, 2012.

Elmore JG and Fenton JJ. Ductal Carcinoma In Situ (DCIS): Raising Signposts on an Ill-Marked Treatment Path. Journal of the National Cancer Institute. Published online ahead of print, April 2012. http://jnci.oxfordjournals.org/content/early/2012/04/05/jnci.djs184.extract Accessed April 9, 2012.

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