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Radiation Therapy for Ductal Carcinoma In Situ: Is It Really Worth It?

Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

To the Editor:

Ductal carcinoma in situ (DCIS) is almost a non–life-threatening disease with 10-year cancer-specific survival of more than 97% as reported in European Organisation for Research and Treatment of Cancer trial 10853.¹ The potential benefit of preventing local recurrences must be weighed in the context of potential morbidity of such preventive treatment (local radiation therapy [RT]) because these women are most likely to fulfill their normal life expectancy. Although this trial showed significant reduction in local recurrences, it reported slightly more (nonsignificant) cancer-specific deaths and distant-metastasis events in the RT arm. Because there is no difference in breast-cancer–specific deaths in two arms, let us examine the number needed to treat for preventing metastatic disease. Approximately 25 invasive cancer recurrences were prevented with RT and approximately one quarter of patients with invasive cancer further developed metastatic disease. This means six to seven of such events were prevented when more than 500 patients received RT—a number needed to treat of almost 100. A recent Early Breast Cancer Trialists' Collaborative Group pooled analysis² shows that RT increases risk of death due to heart disease by 27% (after 15 years). Median age of patients in this trial was 53, which means after 15 years, the majority of them will be in their late 70s. Data from patients with invasive breast cancer³ shows that at this age their likelihood of dying due to breast cancer is less compared with death due to other causes, like cardiovascular diseases. Please note that we are not even counting other causes of death like lung and esophageal cancers caused by RT and all of these hazards of RT have not disappeared with the newer radiotherapy machines.⁴ Expecting RT to save lives of DCIS patients will not be appropriate. On the contrary, it may increase all-cause mortality. Using local RT very cautiously and judiciously only in the high-risk group seems to be the appropriate message to be drawn from this trial.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCES

1. Bijker N, Meijnen P, Peterse JL, et al: Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: Ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III Trial 10853—A study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 24:3381-3387, 2006[Abstract/Free Full Text]

2. Early Breast Cancer Trialists' Collaborative Group (EBCTCG): Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet 366:2087-2106, 2005[Medline]

3. Schairer C, Mink PJ, Carroll L, et al: Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 96:1311-1321, 2004[Abstract/Free Full Text]

4. Darby SC, McGale P, Taylor CW, et al: Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol 6:557-565, 2005[CrossRef][Medline]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thorat, M. A. Articles by Badwe, R. A. Search for Related Content PubMed Articles by Thorat, M. A. Articles by Badwe, R. A. Social Bookmarking                            What's this?