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Home: Oncology Leader Commentary: Monica Morrow, MD

Click on the topic below for comments by Dr Monica Morrow to comment on. You will also find links to related articles and clinical trials.

Putting DCIS in perspective
NSABP B-17: Role of radiotherapy in DCIS
NSABP B-17: Benefits of radiotherapy in DCIS
Silverstein’s approach to radiation
NSABP B-24: Role tamoxifen
Benefits of tamoxifen in DCIS subsets
A model of DCIS management
Mortality and DCIS
DCIS summary
Atypical hyperplasia
Assessment of patients with AH
Intervention options with AH
NSABP PTamoxifen in AH

Excision alone for DCIS

Mortality and DCIS

Presentation, 22nd annual San Antonio Breast Cancer Symposium
(Source: Breast Cancer Update for Surgeons, Program 1 2000)

Play Audio Below:

So, the way that at this point I synthesize my thinking about DCIS, is that there are really two separate and, in some ways, related problems. One is the problem of local recurrence in the breast, which I’ve been talking about, and the other, and ultimately the most important problem, is breast cancer death. And while it’s true that not very many patients with DCIS die of breast cancer, I think it would be very useful to have better predictors of who those patients are going to be. And I have always thought that local failure in the preserved breast, with invasive carcinoma, should be the primary predictor of ultimate breast cancer death. But if you look at the data from the radiated arm of the B-17 trial, 818 patients with a mean follow-up of 90 months, there are 14 breast cancer deaths, not very many.

Relevant Articles

The incidence of positive margins with breast conserving therapy following mammotome biopsy for microcalcification
Cangiarella, J.; Cross, J.; Symmans, W. F.; Waisman, J.; Petersen, B.; D'Angelo, D.; Singer, C., and Axelrod, D.. Journal of Surgical Oncology. 74(4):263-266, 2000 Aug.

Outcomes and factors impacting local recurrence of ductal carcinoma in situ.
Weng, E. Y.; Juillard, G. J. F.; Parker, R. G.; Chang, H. R., and Gornbein, J. A. Cancer. 88(7):1643-1649, 2000 Apr 1.

Risk of subsequent invasive breast cancer after breast carcinoma in situ
Warnberg, F.; Yuen, J., and Holmberg, L. (Reprint available from: Warnberg F Univ Uppsala Hosp, Dept Surg S-75185 Uppsala Sweden).. Lancet. 355(9205):724-725, 2000 Feb 26.

Impact of young age on outcome in patients with ductal carcinoma-in-situ treated with breast-conserving therapy
Vicini, F. A.; Kestin, L. L.; Goldstein, N. S.; Chen, P. Y.; Pettinga, J.; Frazier, R. C., and Martinez, A. A.. Journal of Clinical Oncology. 18(2):296-306, 2000 Jan.

Sentinel node biopsy in ductal carcinoma in situ patients.
Pendas, S.; Dauway, E.; Giuliano, R.; Ku, N. N.; Cox, C. E., and Reintgen, D. S.. Annals of Surgical Oncology. 7(1):15-20, 2000 Jan-Feb.

Carcinoma in situ of the breast: correlation of histopathology to immunohistochemical markers and DNA ploidy.
Ottesen, G. L.; Christensen, I. J.; Larsen, J. K.; Larsen, J.; Baldetorp, B.; Linden, T.; Hansen, B., and Andersen, J. (Reprint available from: Ottesen GL Univ Copenhagen, Inst Forens Med, Dept Forens Pathol Frederik Vs Vej 11,POB 2713 DK-2100 Copenhagen O Denmark).. Breast Cancer Research & Treatment. 60(3):219-226, 2000 Apr In process

Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853.
Julien, J. P.; Bijker, N.; Fentiman, I. S.; Peterse, J. L.; Delledonne, V.; Rouanet, P.; Avril, A.; Sylvester, R.; Mignolet, F.; Bartelink, H., and Van Dongen, J. A. Lancet. 355(9203):528-533, 2000 Feb 12.

Differences in the pathologic features of ductal carcinoma in situ of the breast based on patient age.
Goldstein, N. S.; Vicini, F. A.; Kestin, L. L., and Thomas, M.. Cancer. 88(11):2553-2560, 2000 Jun 1.

Application of the Van Nuys prognostic index in a retrospective series of 367 ductal carcinomas in situ of the breast examinated by serial macroscopic sectioning: Practical considerations.
de Mascarel, I.; Bonichon, F.; MacGrogan, G.; de Lara, C. T.; Avril, A.; Picot, V.; Durand, M.; Mauriac, L.; Trojani, M., and Coindre, J. M. Breast Cancer Research & Treatment. 61(2):151-159, 2000 May. In process

Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy.
Kestin, L. L.; Goldstein, N. S.; Lacerna, M. D.; Balasubramaniam, M.; Martinez, A. A.; Rebner, M.; Pettinga, J.; Frazier, R. C., and Vicini, F. A.. Cancer. 88(3):596-607, 2000 Feb 1.

Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast.
Waddell, B. E.; Stomper, P. C.; DeFazio, J. L.; Hurd, T. C., and Edge, S. B. Annals of Surgical Oncology. 7(9):665-668, 2000 Oct. In process

Ductal carcinoma in situ of the breast: A surgeon's disease.
Silverstein, M. J. (Reprint available from: Silverstein MJ Univ So Calif, Kenneth Norris Jr Comprehens Canc Ctr 1441 Eastlake Ave,Room 7415 Los Angeles, CA 90033 USA). Annals of Surgical Oncology. 6(8):802-810, 1999 Dec. No abstract

Role of specimen radiography in patients treated with skin-sparing mastectomy for ductal carcinoma in situ of the breast.
Rubio, I. T.; Mirza, N.; Sahin, A. A.; Whitman, G.; Kroll, S. S.; Ames, F. C., and Singletary, S. E. Annals of Surgical Oncology. 7(7):544-548, 2000 Aug. In process

Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study.
Ottesen, G. L.; Graversen, H. P.; Blichert-Toft, M.; Christensen, I. J., and Andersen, J. A. (Reprint available from: Ottesen GL Univ Copenhagen, Inst Forens Med, Dept Forens Pathol Frederik Vs Vej 11,POB 2713 DK-2100 Copenhagen Denmark).. Breast Cancer Research & Treatment. 62(3):197-210, 2000 Aug In process

Treatment selection in ductal carcinoma in situ.
Morrow, M. and Schnitt, S. J. (Reprint available from: Morrow M NW Mem Hosp, Lynn Sage Comprehens Breast Ctr 251 E Huron St,Galter 13-174 Chicago, IL 60611 USA).. Jama: Journal of the American Medical Association. 283(4):453-455, 2000 Jan 26. No abstract
FULL TEXT:

Outcomes and factors impacting local recurrence of ductal carcinoma in situ.
Lagios, M. D. and Silverstein, M. J. (Reprint available from: Lagios MD St Marys Med Ctr, Breast Canc Consultat Serv San Francisco, CA 94143 USA).. Cancer. 89(11):2323-2324, 2000 Dec 1. In process

Sentinel lymph node biopsy: Is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion?
Klauber-DeMore, N.; Tan, L. K.; Liberman, L.; Kaptain, S.; Fey, J.; Borgen, P.; Heerdt, A.; Montgomery, L.; Paglia, M.; Petrek, J. A.; Cody, H. S., and Van Zee, K. J. Annals of Surgical Oncology. 7(9):636-642, 2000 Oct. In process

Relation of a recurrent intraductal carcinoma (ductal carcinoma in situ) to the primary tumor Fisher, E. R. and Fisher, B. (Reprint available from: Fisher B NSABP Sci Directors Off 4 Allegheny Ctr,Suite 602 Pittsburgh, PA 15212 USA).. Journal of the National Cancer Institute. 92(4):288-289, 2000 Feb 16. No abstract

Relevant Clinical Trials

Phase III Randomized Study of Tamoxifen With or Without Radiotherapy in Women With Ductal Carcinoma In Situ (DCIS) of the Breast

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