Since there is uncertainty as to which patients will develop a more aggressive breast cancer, all patients are treated as soon as the diagnosis is made. This means the very edge of the cut surface of the specimen needs to be free of cancer cells. Although there have been no studies conducted that directly compare breast-conserving therapy to mastectomy with DCIS, numerous retrospective studies have demonstrated identical cause-specific survival to mastectomy. Radiation therapy will treat these residual tumors and will reduce the risk for local recurrence (tumor returning back in the breast).
Both ductal carcinoma in situ (DCIS) and invasive cancer are known to be multifocal and multicentric.
A woman’s physician will work with her to determine if a lumpectomy is the appropriate decision. A lumpectomy is the removal of the breast cancer and a portion of normal tissue surrounding the mass. Generally following a lumpectomy, radiation treatment is administered to destroy any cancer cells that may not have been removed during the surgery.
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Brachytherapy is an internal type of cancer treatment that allows for the radiation source to be inserted into a tumor or directly on top of a tumor depending on the need, and is available at our state-of-the-art Los Angeles treatment facility. High-dose-rate (HDR) brachytherapy is a temporary radiation treatment and the amount of time that the radiation source is left in place is determined by the physician, most treatments are usually less than 10 minutes.
Recent studies have shown that partial breast brachytherapy may be an acceptable treatment for early stage breast cancer as opposed to whole breast radiation therapy. After a lumpectomy is performed by the surgeon and the primary tumor is removed, a balloon catheter device such as SAVI, Contura or MammoSite is placed in the lumpectomy cavity (pictured). The radiation is delivered through the use of the device twice daily for 5 days for a total of 10 separate radiation sessions on an outpatient basis. Since the balloon is inside the breast in the location where the tumor was previously located, this delivers radiation to the tumor bed where the tumor is most likely to recur, while minimizing radiation to the rest of the breast tissue.

Studies have shown that the SAVI, Contura and MammoSite partial breast HDR brachytherapy radiation is well-tolerated, with minimal short-term side effects. Brachytherapy is an integral part of the treatment course for many patients with endometrial and cervical cancers. Patients are often first treated with pelvic radiation therapy after which time they are treated with HDR brachytherapy. To schedule an appointment, please call Beverly Hills Cancer Center in Beverly Hills, California at (877) 351-0088 or use our interactive Online Appointment Request Form.
The device is easily removed on the last day of treatment in the office or radiation suite. What We DoEach patient is evaluated using a multidisciplinary approach and a team of cancer experts. The Super Soft Bra provides breast support and comfort during conventional Radiation Therapy. The standard treatment of DCIS includes a lumpectomy (preserving the breast) with radiation therapy or a mastectomy (complete removal of the breast). Breast conservation is not an option due to the extent of the disease throughout the breast. Despite complete resection of the tumor during lumpectomy, some women with DCIS remain at a higher risk of recurrence unless they undergo additional radiation therapy.
Overall, in patients who undergo radiation therapy, the relative risk of a recurrence by either DCIS or invasive cancer is reduced by 50%. There are other cases where DCIS is an indolent disease and will not progress to invasive cancer. When performing the procedure, the surgeon may also remove some lymph nodes from under the arm to determine if the cancer has spread, this is called a sentinel node biopsy.
Minimally invasive surgical techniques are used to decrease post-operative pain and speed up recovery. This means there is a need to go back for a second surgery in order to clear the breast of cancer cells. It does not necessarily reflect the aggressiveness of the cancer cells, but their distribution throughout the breast.
If your surgeon cannot feel the lump to be removed, the radiologist will be asked to insert a guide wire into your breast prior to surgery to pinpoint the area of concern; this is called a needle-localization.

Individualized care is offered based on the patient's comorbid conditions, their tumor type, and its location. A woman may choose this option over a lumpectomy if she is unwilling to undergo radiation therapy. Women with DCIS can be left with these tumor foci despite obtaining negative resection margins (no tumor cells at the very cut edge of the surgical specimen). The goal of radiation therapy is to eradicate this residual disease and decrease the incidence of local recurrence. Many patients with breast cancer do not qualify for partial breast treatments and require whole breast radiation therapy which is given daily for approximately 5-6 weeks. In select cases, genetic analysis of the tumor is performed to search for drugs that can block important signaling pathways and thereby slow growth and kill cancer cells. The advantage of doing breast conservation or a lumpectomy is one and only, the preservation of the breast. We discussed earlier that DCIS means cancer cells are within the duct and do not have the potential to spread.
Breast conserving therapy implies complete removal of the breast tumor with a concentric margin of surrounding healthy tissue in a cosmetically acceptable manner. The decision to preserve the breast implies a risk for "in breast recurrence" (cancer returning back in the future), or a new primary breast cancer in the same breast.
It is important to acknowledge that after diagnosing DCIS by a needle core biopsy (streotactic biopsy) there is the possibility of finding an invasive cancer in approximately 10% to 20% of cases. The intent of radiation therapy delivery in DCIS is to eradicate subclinical foci of residual disease and to minimize the risk for local recurrence following surgery.
With this in mind, it is recommended to proceed with a sentinel node biopsy if a mastectomy has been elected.
This will avoid the need of an axillary node dissection in the case that the mastectomy specimen reveals an invasive component. We also recommend a sentinel node biopsy in selective breast conserving cases depending on tumor characteristics.

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