Testing not Conserved After Conserving Surgery

Early breast cancer patients have high number of tests following surgery

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Treating ductal carcinoma in situ (DCIS), which is early breast cancer, usually involves breast conserving surgery (lumpectomy).  

According to new research, post-surgical testing to make sure the cancer hasn't returned is anything but conservative.

Women diagnosed with DCIS who undergo breast conserving surgery (BCS) often have a high number of diagnostic tests following treatment. These include biopsies, invasive procedures that test suspicious areas for cancer cells.

"Find out how often you need to be screened following breast cancer."

To learn just how many procedures are typically conducted on women who've beaten early breast cancer, Larissa Nekhlyudov, M.D., M.P.H., assistant professor in the Department of Population Medicine at Harvard Medical School, analyzed data gathered from three large healthcare systems.

Dr. Nekhlyudov and colleagues at Beth Israel Deaconess Medical Center and Kaiser Permanente California reviewed information on women with DCIS who had lumpectomies between 1990-2011 and were followed for up to a decade.

Researchers found that over 10 years, nearly 31 percent of the women had diagnostic mammograms, and 61.5 percent had biopsies on the breast where the cancer had appeared.

The authors note there were study limitations because women who had mastectomies in the first six months following breast conserving surgery were eliminated. As a result, the number of tests may be underestimated.

"The fact that women undergoing BCS are likely to have diagnostic and invasive breast procedures in the conserved breast over an extended period of time is important and needs to be included in discussions about treatment options."

dailyRx asked Adam Brufsky, M.D., Ph.D., professor of medicine at the University of Pittsburgh School of Medicine, for his perspective on this study. "It is interesting that more procedures appear to be done on the ipsilateral [side where cancer appeared]  breast after lumpectomy.

"This should be taken into account when women choose breast preservation," Dr. Brufsky told dailyRx.

In an accompanying editorial, Joann G. Elmore, M.D., M.P.H. at the University of Washington School Of Medicine and Joshua J. Fenton, M.D., M.P.H., at the University of California, Davis Medical School, wrote that moderation is needed.

"We need to learn how to avoid over-diagnosis by calling back fewer women for additional testing after screening mammography; we also need better prognostic biomarkers so as to minimize over-treatment of lesions that are unlikely to progress to invasive cancer," they write.

Results from this study were published April 5, 2012  in the Journal of the National Cancer Institute.

Financial disclosures and funding information were not provided.

Reviewed by: 
Review Date: 
April 10, 2012
Last Updated:
September 27, 2012