Delaying Radiation After DCIS Surgery Ups Recurrence Risk
Women diagnosed with DCIS who have radiation more than 8 weeks after surgery have a higher risk of DCIS recurrence or developing invasive disease in the same breast.
DCIS (ductal carcinoma in situ) is the most common form of non-invasive breast cancer and is considered stage 0 cancer. While DCIS isn’t considered life threatening, it does increase the risk of developing invasive breast cancer later in life.
DCIS usually is treated with surgery to remove the cancer -- lumpectomy in most cases. After surgery, hormonal therapy may be recommended if the DCIS is hormone-receptor-positive (most are). Radiation therapy also is recommended for many women. Both hormonal therapy and radiation help reduce the risk of the DCIS recurring (coming back), as well as the risk of invasive cancer.
Radiation therapy after DCIS was common in the past, but some newer DCIS treatment guidelines say that women at low risk of recurrence may be able to skip radiation therapy after surgery. Still, some research suggests that women diagnosed with DCIS with a low risk of recurrence who didn’t receive radiation after lumpectomy have a higher risk of DCIS recurrence or developing invasive disease in the same breast in the 12 years after surgery.
Echoing these earlier results, a study has found that women diagnosed with DCIS who delay radiation therapy after surgery have a higher risk of DCIS recurrence or developing invasive disease in the same breast.
The study was presented on April 18, 2016 at the American Association for Cancer Research Annual Meeting. Read the abstract of "Radiation therapy delay and risk of ipsilateral breast tumors in women with ductal carcinoma in situ."
To do the study, the researchers looked at the records of 5,916 Missouri women who were diagnosed with DCIS from 1996 to 2011 and had lumpectomy.
The researchers considered having radiation therapy within 8 weeks of surgery to be timely with no delay. While most of the women had radiation with no delay, nearly 50% did not:
- 17.8% (1,053 women) had radiation therapy more than 8 weeks after surgery
- 28.8% (1,702 women) did not have radiation therapy
- 53.4% (3,161 women) had radiation within 8 weeks of surgery
During the 6 years of follow-up, 3.1% of the women had a DCIS recurrence or were diagnosed with invasive breast cancer in the same breast.
The researchers used statistical methods to adjust the data for several factors that could affect the risk of recurrence, including age, cancer characteristics, and whether the women also were treated with hormonal therapy.
The results showed that compared to women who had timely radiation therapy, the risk of recurrence was:
- 26% higher for women who had delayed radiation therapy
- 35% higher for women who did not have radiation therapy
Delays in receiving radiation therapy were more likely among Black women, unmarried women, women diagnosed with larger DCIS, and women who had Medicaid insurance.
"This study indicates not only that radiation therapy is an important component in the treatment of DCIS but also that it must be received in a timely manner," said Ying Liu, M.D., Ph.D., researcher at the Washington University School of Medicine and the study's lead author. "What we've found suggests the need for more studies. Our hope is to provide clear-cut guidelines that will help more women reduce their risk of recurrence."
If you’ve been diagnosed with DCIS or invasive breast cancer, it makes sense to take the time to do some research to make sure your diagnosis is correct and your treatment plan makes sense. But it also makes sense to have timely treatment.
If your insurance has large copays or you are unemployed, you may be considering delaying your treatment because you’re worried about how you’ll pay for it. Don’t panic and don’t skip any doctor’s visits or delay your treatment. Your life may depend on it. There are resources available to help you.
Someone at your doctor’s office may be able to give you a list of organizations that offer financial assistance for breast cancer treatments and care, as well as local organizations that offer financial assistance for your practical needs, such as transportation, food, and child care.
Also, many hospitals now include patient navigators as part of the breast cancer care team. A patient navigator can help you understand and move through the healthcare and insurance systems. Patient navigators also can help overcome language and cultural barriers, as well as any biases based on culture, race, or age and can help you and your doctor communicate better. Ask your doctor or nurse for a patient navigator recommendation.
There is only one of you and you deserve the best care possible, given in a timely manner. Don’t let any obstacles get in the way of your treatment!
For more information on how you can get financial help, visit the Breastcancer.org Paying for Your Care pages.
— Last updated on February 22, 2022, 10:02 PM
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