New DCIS consensus guideline could curb unnecessary breast surgery and reduce health system costs

From American Society for Radiation Oncology:

ROSEMONT, Ill., ARLINGTON, Va., ALEXANDRIA, Va. – Three leading national cancer organizations today issued a consensus guideline for physicians treating women who have ductal carcinoma in situ (DCIS) treated with breast-conserving surgery with whole breast irradiation. The new guideline has the potential to save many women from unnecessary surgeries while reducing costs to the health care system.

The Society of Surgical Oncology (SSO), the American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO) together published the new guideline in their respective journals, the Annals of Surgical Oncology, Practical Radiation Oncology and the Journal of Clinical Oncology.

The groups concluded, “The use of a two millimeter margin as the standard for an adequate margin in DCIS treated with whole breast radiation therapy (WBRT) is associated with low rates of recurrence of cancer in the breast and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins less than two millimeters. Margins more widely clear than two millimeters do not further reduce the rates of recurrence of cancer in the breast and their routine use is not supported by evidence.”

Supported by a grant from Susan G. Komen, SSO spearheaded the guideline initiative and established a panel of experts from the three organizations, including clinicians, researchers and a patient advocate to create the new guideline to provide clarity regarding the optimal negative margin width for ductal carcinoma in situ.

To determine the margin width, a pathologist paints the outer surface of the tissue that’s been removed with ink. A clear, negative, or clean margin means there are no cancer cells at the outer inked edge of tissue that was removed, while a positive margin means that cancer cells …

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