Expert Point of View: Julie Margenthaler, MD


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Julie Margenthaler, MD

Julie Margenthaler, MD

“This study of 2,759 patients with ductal carcinoma in situ provides data for women who are considering their surgical options,” said Julie Margenthaler, MD, a breast surgeon at Washington University of Medicine, St. Louis, and Communications Chair of the American Society of Breast Surgeons (ASBrS) Annual Meeting. “The rate of contralateral breast cancer was only 5% to 6% at 10 years, and this was further reduced by the use of endocrine therapy. Thus, bilateral mastectomy in the setting of unilateral [ductal carcinoma in situ] should be the exception rather than the routine. The ASBrS has published consensus guidelines1 to help clinicians discuss these complex treatment decisions with patients.”

Range of Reactions

Judy C. Boughey, MD, Professor of Surgery at the Mayo Clinic, Rochester, noted the wide range of patient reactions to a diagnosis of ductal carcinoma in situ, from double mastectomy to the avoidance of any surgery in favor of observation—a strategy now being evaluated in clinical trials. Overtreatment clearly comes at a cost, she pointed out. At the ASBrS meeting, Dr. Boughey presented data from a commercial insurance database showing that bilateral mastectomies with immediate reconstruction increase hospital length of stay, emergency room visits, inpatient admissions, and total 2-year cost of care for implant reconstruction, over unilateral mastectomy with immediate reconstruction.2

She said the 10-year 6% risk of contralateral breast cancer in women with ductal carcinoma in situ is the number she has quoted to breast cancer patients for years, including those with invasive disease, and that is further decreased with endocrine therapy. “That’s very important information for us to make our patients aware of,” she said. “We tell them the risk in the opposite breast is very low and reassure them that they do not need to remove their normal breast for their breast cancer treatment.” ■

Disclosure: Drs. Margenthaler and Boughey reported no conflicts of interest.

References

1. Boughey JC, et al: Ann Surg Oncol 23:3106-3111, 2016.

2. Boughey J, et al: 2017 ASBrS Annual Meeting. Abstract 256902.


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