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DCIS Treatment Changes Haven’t Had an Effect on Deaths

Breast cancer survival rates remain the same despite shifts in treatment

Shifts in treatment since 1999 from single mastectomy toward lumpectomy with radiation for ductal carcinoma in situ (DCIS) haven’t changed breast cancer survival rates, according to a study published in the Journal of the National Cancer Institute that examined records from more than 120,000 women.

As noted by National Public Radio, the vast majority of women diagnosed with DCIS (abnormal cells that sometimes, but not always, become breast cancer) have surgery, even though there's considerable debate about whether it's needed.

The highest overall survival rate after 10 years, 89.6%, was in women who had lumpectomy with radiation. The survival rate for women who had mastectomies was 86%, followed by lumpectomy alone at 80.6%. But most women in the study group who died didn't die of breast cancer; cardiovascular disease was the major killer, with just 9% of deaths overall due to breast cancer. Looking at deaths from breast cancer alone, the 10-year survival rates were pretty much identical: 98.9% for lumpectomy plus radiation; 98.5% for mastectomy, and 98.4% for lumpectomy alone.

Between 1991 and 2010, the number of women who chose lumpectomy with radiation almost doubled, the study found, rising from 24% to 47%. The number of women choosing single mastectomy dropped from 45% to 19%.The number of women who chose no treatment, which usually involves screening mammograms, rose from 1% to 3%. But more women also started choosing bilateral mastectomy, which usually involves removing a healthy breast as well as a breast with DCIS. Those numbers rose from zero in 1991 to 8.5% in 2010. Such patients tended to be younger women.

"The troubling trend in my point of view is that more women are getting bilateral mastectomies," says Shelley Hwang, senior author of the study and chief of breast surgery at the Duke Cancer Institute. "That's because there's a limited understanding on how good the treatment is for DCIS. I'm not saying that women don't die from breast cancer; they do. But the cures have never been better, and your likelihood of surviving is greater than 90%."

Source: NPR, October 14, 2015.

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