Consensus Reached for Ductal Carcinoma In-Situ Treatment Guidelines

A panel of oncology experts recently created new breast cancer surgery guidelines that prevent unnecessary surgeries and reduce healthcare costs.

The Society of Surgical Oncology (SSO), American Society for Radiation Oncology (ASRO), and American Society of Clinical Oncology (ASCO), teamed up to form new guidelines for patients with ductal carcinoma in situ (DCIS). The organizations created a panel that included clinicians, researchers, and patient advocates.

Researchers found that using a 2 millimeter margin as the standard margin in DCIS treated with whole breast radiation therapy (WBRT) is linked to low recurrence and could decrease re-excision rates, improve cosmetic outcomes, and decrease healthcare costs, according to a study published by the organizations in the Annals of Surgical Oncology, Practical Radiation Oncology and the Journal of Clinical Oncology. Increased margins were not found to reduce the rates of recurrence, and the organizations do not suggest expanding the margin any further.

In a clinical setting, a pathologist paints the outer surface of the removed tissue with ink to determine the margin width. A clear margin indicates there are no cancer cells at the edge, and a positive margin indicates there are still cancer cells at the edge of the tissue that was removed. Approximately 1 in 3 patients have to undergo a re-excision due to a lack of consensus about the optimal negative margin, according to the study.

Re-excisions increase discomfort, complications, and can have poor cosmetic outcomes in addition to increased costs.

“An important finding from the review of the published literature performed to provide evidence for this guideline is that margin widths greater than 2 millimeters (approximately 1/8th of an inch) do not reduce the risk of cancer recurring in the breast in women with DCIS who are treated with lumpectomy and whole breast radiation therapy,” said Monica Morrow, MD, past SSO president and panel co-chair, Memorial Sloan Kettering Cancer Center, Breast Service, Department of Surgery.

To reach the consensus, the panel reviewed 30 studies containing 7883 patients to develop consensus guidelines about margin width and cancer recurrence. Panel members continue to advise that patients consult with physicians who recommend a re-excision if the patient had a negative margin.

"With this guideline, it is our 2-pronged goal to help physicians improve the quality of care they provide to women undergoing surgery for DCIS and ultimately improve outcomes for those patients. We hope the guideline also translates into peace of mind for women who will know that future surgeries may not be needed," said Mariana Chavez-MacGregor, MD, University of Texas MD Anderson Cancer Center and panel member representing ASCO.