Can I skip radiation after lumpectomy DCIS?
Routine radiation therapy after DCIS was common in the past, but some newer DCIS treatment guidelines say that women at low-risk for recurrence may be able to skip radiation therapy after surgery.
Radiation reduces the risk of local recurrence to about one-half of that without radiation therapy. When DCIS recurs, half of the recurrences are still DCIS but the other half are invasive breast cancers.
Ductal carcinoma in situ (DCIS) is a low-risk form of early-stage breast cancer. Women with DCIS can have radiation after the tumor is removed to lower the risk that the cancer could come back. A new study provides more evidence that radiation after surgery can greatly reduce the chance of DCIS returning.
Local treatment for DCIS usually involves breast-conserving therapy (BCT), which consists of lumpectomy (also called wide excision or partial mastectomy) followed in most cases by adjuvant radiation therapy (RT). Alternatively, mastectomy may be considered.
Over an average follow-up of five years, the study revealed that the rate of breast cancer recurrence in the same breast was 2.3% in women who skipped radiation after lumpectomy and took endocrine blockers instead — the same rate expected with radiation use, which was impressive, Dr. Tung says.
Missed Radiation Therapy Sessions Increase Risk of Cancer Recurrence. Patients who miss radiation therapy sessions during cancer treatment have an increased risk of their disease returning, even if they eventually complete their course of radiation treatment, according to a new study.
Radiation therapy
It is used to lower the risk that cancer will come back (recur) in the breast, especially if there is high-grade DCIS. In rare cases, radiation therapy isn't needed because the DCIS is low grade, it is only in one very small area of the breast and it is completely removed with surgery.
Radiation is typically used after lumpectomy. But it might not be necessary if you have only a small area of DCIS that is considered low grade and was completely removed during surgery.
Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up24–27 and a normal life expectancy.
Patients with DCIS have a 15% chance of invasive local recurrence, Dr. Narod noted, but “preventing the invasive local recurrence has nothing to do with preventing death.
Should I have radiotherapy after DCIS?
After a wide local excision (WLE), your cancer doctor will usually recommend you have radiotherapy to the breast if your DCIS is high grade. If your DCIS is low or intermediate grade, your cancer doctor may not recommend that you have radiotherapy. You usually start radiotherapy about 4 to 6 weeks after surgery.
The abnormal cells are confined within a single duct, and they often grow more slowly than most cancer cells. However, around 20 percent of DCIS cases eventually transform into invasive cancer or recur after the primary tumor is removed.
Radiation therapy for DCIS is usually given every day, 5 days a week, for 3-4 weeks. Learn about going through radiation therapy. For a summary of research studies on lumpectomy plus whole breast radiation therapy in the treatment of DCIS, visit the Breast Cancer Research Studies section.
Hormonal therapy is recommended for some women with DCIS to help prevent breast cancer from developing and to prevent DCIS from returning after it has been surgically removed. It is only effective for women whose DCIS is “estrogen receptor positive”, which DCIS usually is.