Surgeon: Some breast cancers can be excised safely

Wednesday, March 21, 2001 | 10:28 a.m.

A California surgeon said an ailment that accounts for nearly 20 percent of all breast cancer cases can often be safely treated without resorting to mastectomies or radiation.

Dr. Melvin Silverstein, surgery professor at the University of Southern California's Keck School of Medicine, told more than 500 breast center delegates at the Tropicana hotel-casino Tuesday that ductal carcinoma in situ, or DCIS, can be successfully excised without removing the breast in many cases.

"I hear a lot of women with DCIS who fear they will get chemotherapy and that their hair will fall out," Silverstein said. "But that is not necessarily the case. This is breast cancer, but it is on the unaggressive edge of the spectrum. No one ought to die from DCIS."

Silverstein, the keynote speaker at the 11th annual Breast Center Conference, described DCIS as a group of heterogeneous diseases normally found in only one area of the breast not far from the original lesion. Major advances in mammography have increased knowledge of this ailment, he said.

"You can't feel it with your fingers or see it with your eyes," he said.

It is estimated in the United States this year there will be 193,700 new breast cancer cases, including 46,400, or 19 percent, categorized as DCIS. An estimated 40,200 women are expected to die from breast cancer in 2001.

Silverstein, a breast center pioneer, said excision alone might not be enough for women younger than 40 with larger DCIS tumors because the risk of death through recurrence could still exist. But he said excision alone can work in many cases for older women with small tumors, adding that the risk of a cancerous recurrence is reduced by 70 percent in women who reach 60.

"Mastectomies are an incredibly effective treatment for this disease," Silverstein said. "There's a 1 percent recurrence risk and zero percent fatality rate. But for most people a mastectomy is overkill and overtreatment."

He said, however, that many DCIS patients opt for mastectomies anyway because of new skin-sparing techniques that make breast reconstruction possible. Silverstein said he has found that many of his medical students, given three seconds to look at a patient, cannot tell which breast has been reconstructed using this technique.

Many women receive radiation treatments for DCIS, but he said the alternative is expensive and inconvenient and might increase the risk of cardiovascular-related death. That risk might not be worth it to a woman who is a good candidate for excision, he said.

Fellow speaker Dr. R. James Brenner, chief of mammography at St. John's Hospital in Santa Monica, Calif., played up the necessity of early detection as a life-saving technique. But he warned about expenses associated with advanced mammographic technology, such as that which involves computers.

"The most important issue we now face is the economics of mammography," Brenner said. "The cost issue will continue to evolve over the next couple of years."

The three-day conference, which covers topics ranging from breast cancer diagnosis to breast health care programs, ends today.