Women's College Hospital - Health Care for Women, Revolutionized

Jump to body content

Radiation therapy plus lumpectomy is associated with better survival than total mastectomy in women with DCIS

WCH study finds lumpectomy plus radiation associated with a small clinical benefit in reducing the risk of breast cancer death in women with ductal carcinoma in situ (DCIS)

August 10, 2018  |  Download Release

Toronto, August 10, 2018 – Why the Research is Interesting: Patients with DCIS are often treated with radiation after lumpectomy, although it has remained unclear whether this can reduce the risk of dying from breast cancer.

Who and When: More than 140,000 U.S. women who had DCIS between 1998 and 2014; this study compared lumpectomy plus radiation vs. lumpectomy alone, lumpectomy vs. mastectomy, and lumpectomy plus radiation vs. mastectomy.

What (Study Measures and Outcomes): Use of radiation and/or extent of surgery (exposures); breast cancer mortality rates within 15 years (outcomes).

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors:  Vasily Giannakeas, MPH, Victoria Sopik, MSc, and Steven A. Narod, M.D., of Women’s College Research Institute and the Dalla Lana School of Public Health at the University of Toronto. Giannakeas and Sopik are doctoral students of Dr. Narod.

Results: Among 29,865 women treated with mastectomy, there were 240 in breast recurrences and 254 deaths from breast cancer. Among the same number of women treated with lumpectomy and radiation there were 621 in breast recurrences and 207 deaths from breast cancer. A small improvement in breast cancer survival was associated with radiation plus lumpectomy for DCIS (25 per cent reduction in deaths). The absolute risk reduction was small, making it necessary to treat 370 women with radiotherapy to save one life. However, the beneficial effect was much stronger for young women, black women and women with large DCIS lesions.

Study Limitations: Some data were missing; investigators didn't have information on tamoxifen use; treatments in the study population weren't randomly assigned; and the possibility remains that the decision to undergo radiotherapy was associated with other favorable prognostic factors.

Study Conclusions: Among patients with DCIS, treatment with lumpectomy and radiotherapy is associated with better survival than patients who were treated with total mastectomy – a much more extensive surgery. This surprising result suggests that in a small proportion of patients with DCIS the cancer has spread beyond the breast at the time of diagnosis and can be treated successfully with radiotherapy. This observation supports our previous position that DCIS better resembles a small invasive cancer than a precursor lesion. It is intriguing that radiotherapy has this beneficial effect, which appear to be attributable to systemic activity rather than local control. Future studies should examine how radiotherapy affects survival.

-30-

Jump to top page

About

About Women’s College Hospital

For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.

Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.

For more information about how WCH and WCRI are transforming patient care, visit www.womenscollegehospital.ca and www.womensresearch.ca

More News & Media »

Media inquiries

Please contact Media Relations

Email: media@wchospital.ca

Phone: 416-323-6400 ext. 4054


Media Kit

Please visit our Media Kit page for resources such as images, B-roll video and backgrounders on Women's College Hospital.

  • Fully affiliated with:
  • University of Toronto

  • A member of:
  • Council of Academic Hospitals of Ontario (CAHO)