
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: WEDNESDAY, May 19, 1993                   TAG: 9305190123
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO  
SOURCE: Associated Press
DATELINE: ORLANDO, FLA.                                LENGTH: Medium

EARLY BREAST LUMP SURGERY URGED

A major study shows a combination of lump-removing surgery and radiation is the best way to treat a nationwide "plague" of tiny localized breast cancer, rather than relying on lumpectomy alone.

These minuscule early tumors - what doctors call ductal carcinoma in situ - have not spread beyond milk ducts in the breast. Most are too small to be felt and show up only on breast X-rays.

These tumors were once considered to be rare. But because of the wide use of mammograms in the past decade, they are being recognized with dramatically increasing frequency. An estimated 182,000 new cases of breast cancer are expected to be diagnosed this year, and at some hospitals the tiny early tumors make up one-quarter of all cases.

"We face a plague of ductal carcinoma in situ," commented Dr. William Wood of Emory University.

Until now, there has been no agreement on how this stage of the disease should be handled. While surgery, radiation therapy and sometimes chemotherapy are standard for more advanced cancer, the treatment of ductal carcinoma in situ ranges from simple lumpectomy to breast removal.

The new study was intended to settle this question. It was based on 818 women who were randomly assigned to have either lumpectomy alone for their early breast cancer or lumpectomy plus radiation.

The research showed that the addition of radiation therapy clearly improves the chances of avoiding new cancer, at least in the short term.

After five years of follow up, 16 percent of the women in the radiation group had experienced a recurrence of cancer or had died, compared with 26 percent among those who got only lumpectomies. The annual occurrence of these so-called "adverse events" was 47 percent lower in the radiation patients. The risk of new tumors in the same breast was 59 percent reduced in these women.

The study was conducted by Dr. Bernard Fisher and colleagues from the University of Pittsburgh and presented at the annual scientific meeting of the American Society of Clinical Oncology, which concluded Tuesday.

These and similar studies often are criticized because breast cancer is a slow-growing disease, and many years of follow up are necessary to know if a particular therapy truly works better. This is one reason why some surgeons have been reluctant to switch from performing mastectomies to lumpectomies.

by CNB