NCCN Guidelines for Patients® | Breast Cancer - page 62

NCCN Guidelines for Patients™: Breast Cancer
Version 2.2011
Lymph node surgery is generally not done with DCIS.
However, the pathologist may find that you have
invasive cancer and a sentinel lymph node biopsy would
not be possible after some surgeries. Thus, having a
lymph node biopsy before such surgeries may help
decide which treatment you need.
The margin in the breast tissue sample should be more
than 1 mm. If DCIS is in only 1 area and the margin is
cancer free, your surgical choices are a lumpectomy or
total mastectomy. If you have a low risk of recurrence,
radiotherapy may not be needed after a lumpectomy.
For other women, radiotherapy to the whole breast with
a boost to the tumor site can help prevent recurrence.
Fully discuss excluding radiotherapy with your doctor.
If interested in partial breast irradiation, the NCCN
Guidelines Panel suggests taking part in a clinical
trial. After lumpectomy, a mammogram is suggested
to ensure that the entire area of DCIS has been
removed. Studies have shown that women treated with
lumpectomy and radiotherapy for DCIS are in no greater
danger of dying from breast cancer than those who have
a mastectomy.
Part 7: A step-by-step treatment guide
If DCIS can’t be completely removed with a lumpectomy,
a mastectomy is recommended. There are 2 other
reasons to receive a mastectomy for DCIS. First, it is
recommended if cancer cells are found in the tissue
margin from a lumpectomy. Second, a mastectomy is
needed if the biopsy shows 2 or more areas of DCIS
that can’t be removed with 1 surgical cut into the breast.
Radiotherapy is not needed following a mastectomy
unless cancer cells are found in the tissue margin.
Following a mastectomy, you may decide to have breast
reconstruction. Reconstruction can be done at any time.
A skin-sparing mastectomy keeps some skin to allow the
breast to look more natural after breast reconstruction.
Reconstruction should be performed by an experienced
breast surgery team. To reduce your risk of recurrence,
tamoxifen is an option. If you were treated with
lumpectomy, consider taking tamoxifen for 5 years,
especially if you have an estrogen receptor–positive tumor.
For any woman with DCIS, use of tamoxifen for 5 years
can reduce the risk of breast cancer developing in the
other breast.
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