PMID- 27527719 OWN - NLM STAT- MEDLINE DCOM- 20180202 LR - 20220408 IS - 1534-4681 (Electronic) IS - 1068-9265 (Linking) VI - 24 IP - 1 DP - 2017 Jan TI - Are We Overtreating Ductal Carcinoma in Situ (DCIS)? PG - 59-63 LID - 10.1245/s10434-016-5501-z [doi] AB - OBJECTIVE: During 2015, the media was flooded with the issue of whether ductal carcinoma in situ (DCIS) was being overtreated and whether favorable cases could be simply watched (core biopsy only followed by surveillance). To answer this question, we looked at DCIS patients treated with excision alone with margin width <1 mm as inadequate and a surrogate for no treatment (surveillance group) and margin >/=1 mm as adequate surgical excision (excision group). METHODS: A total of 720 patients with pure DCIS treated with excision alone were stratified into two groups based on margin width and further subdivided by nuclear grade. Kaplan-Meier analysis was used to determine local recurrence-free survival. Differences in outcome were analyzed using the log-rank test. RESULTS: The 10-year local recurrence probabilities are statistically significant for low-grade versus high-grade and surveillance alone versus excision alone. The comparison of excision alone group with margins >/=1 mm for low-grade DCIS versus high-grade DCIS shows a 10-year local recurrence-free survival rate of 13 versus 35 % (p < 0.0001). The surveillance group had (margins <1 mm) had higher rates of recurrence in both the low-grade group (51 %) and high-grade group (70 %) (p < 0.001). CONCLUSIONS: This study indicates that there is not an acceptable level of local control in DCIS patients with tumor margins <1 mm that undergo active surveillance, regardless of tumor grade. Leaving even low-grade DCIS untreated would lead to local recurrence in more than half the patients in 10 years. Needle biopsy and surveillance for DCIS, regardless of grade, is just not adequate at this time. FAU - Khan, Sadia AU - Khan S AD - Hoag Breast Care Program, Hoag Memorial Hospital Presbyterian, Newport Beach, USA. drkhanbreastsurgery@gmail.com. AD - Department of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, USA. drkhanbreastsurgery@gmail.com. FAU - Epstein, Melinda AU - Epstein M AD - Department of Clinical Research, Hoag Breast Care Program, Hoag Memorial Hospital Presbyterian, Newport Beach, USA. FAU - Lagios, Michael D AU - Lagios MD AD - The Breast Cancer Consultation Service, Tiburon, CA, USA. FAU - Silverstein, Melvin J AU - Silverstein MJ AD - Hoag Breast Care Program, Hoag Memorial Hospital Presbyterian, Newport Beach, USA. AD - Department of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, USA. LA - eng PT - Journal Article DEP - 20160815 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Biopsy, Needle MH - Breast Neoplasms/pathology/*surgery MH - Carcinoma in Situ/pathology/*surgery MH - Carcinoma, Ductal, Breast/pathology/*surgery MH - Female MH - Humans MH - Middle Aged MH - Neoplasm Grading MH - Neoplasm Recurrence, Local/pathology MH - Survival Rate MH - Treatment Outcome MH - Watchful Waiting EDAT- 2016/08/17 06:00 MHDA- 2018/02/03 06:00 CRDT- 2016/08/17 06:00 PHST- 2016/03/28 00:00 [received] PHST- 2016/08/17 06:00 [pubmed] PHST- 2018/02/03 06:00 [medline] PHST- 2016/08/17 06:00 [entrez] AID - 10.1245/s10434-016-5501-z [pii] AID - 10.1245/s10434-016-5501-z [doi] PST - ppublish SO - Ann Surg Oncol. 2017 Jan;24(1):59-63. doi: 10.1245/s10434-016-5501-z. Epub 2016 Aug 15.