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Self-Assessment Questions


Answer 1
  1. Perform lumpectomy, followed by radiation therapy, and consider administration of tamoxifen for 5 years. Ductal carcinoma in situ (DCIS) is considered a premalignant lesion that may progress to invasive breast cancer over the course of several years. It is necessary to remove DCIS with clear surgical margins. Approximately half of the local recurrences are invasive cancer, whereas the remaining ones are DCIS. If lumpectomy is performed, postoperative radiation also is necessary to further reduce risk for local recurrence in most women. Tamoxifen therapy following lumpectomy and radiation therapy further reduces the risk of invasive or noninvasive recurrence by as much as 50%, compared with no tamoxifen therapy. However, the absolute benefit from this hormonal treatment is small. In the National Surgical Adjuvant Breast Project (NSABP) protocol B-24 study, a large randomized trial of 1804 women with DCIS, the cumulative incidence of invasive breast cancer recurrence at 5 years was 4.1% in the tamoxifen-treated group, compared with 7.2% in the placebo group. The overall survival was not different between the 2 groups.1

    1. Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 1999;353:1993–2000.

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