Intraductal Carcinoma - Treatment


The main treatment for intraductal carcinoma used to be mastectomy. This treatment therapy consists in the removal of the affected breast and until recently it was the only way in which this condition was treated. The rationale for mastectomy includes a 30% incidence of multicentric disease, a 40% prevalence of residual tumor at mastectomy following wide excision alone, and a 25% to 50% incidence of breast recurrence following limited surgery for palpable tumor, with 50% of those recurrences being invasive carcinoma.

Another treatment option consists of breast-conserving surgery along with radiation therapy. This type of treatment is usually considered in patients with non-palpable lesions and microcalcifications that may be seen on a mammography. Breast-conserving surgery, also referred to as lumpectomy, is considered nowadays a reasonable approach in the treatment of intraductal carcinoma. A lumpectomy consists in the removal of the tumor and a part of the surrounding tissues of the breast. Sometimes, lumpectomies are also referred to as partial mastectomies because they mainly consist in the removal of a part of the breast tissue. The National Surgical Adjuvant Breast and Bowel Project (NSABP) and the European Organization for Research and Treatment of Cancer (EORTC) have carried out clinical trials in order to establish whether lumpectomies and radiation therapy are more efficient in the management of intraductal carcinoma when comparing to the conservative method, mastectomies. Lumpectomies are commonly performed with radiation therapy to avoid noninvasive cancer from recurring or from developing into invasive cancers.

The clinical trials completed by the first organization (NSABP-B-17) concluded that radiation therapy given at the same time with breast-conservative surgery may decrease the recurrence rate with nearly a half, from 31% to 15%. Also, this type of treatment may reduce the occurrence of invasive cancer to nearly 8% from nearly 17% and recurrence rate of intraductal carcinoma to 8% from nearly 15%.

According to the results of the trials carried out by EORTC (EORTC-10853), radiation therapy has a consistent efficiency in treating intraductal carcinoma. This clinical trial showed that the recurrence rate of breast carcinoma may be reduced with 10%, from which invasive cancer recurrence was reduced with 5% and noninvasive cancer recurrence with 7%. This study also concluded that the risks of recurrence are greatly dependent on the age of the patient, the type of carcinoma (intermediate or poorly differentiated), the indeterminate margins of the tumor and the growth pattern.

Mastectomies however remain the main treatment option in patients with persistent microscopic involvement of margins after local excision or with a diagnosis of intraductal carcinoma and evidence of suspicious, diffuse microcalcifications.

A clinical study carried out by NSABP revealed that Taximofen may reduce the incidence of contralateral breast neoplasms (invasive and noninvasive) from 0.8% per year to 0.4% per year and the ipsilateral invasive breast cancer with 2% at 5 years.

Chemotherapy is thought to be inefficient in treating this type of noninvasive breast cancer and the role of hormonal therapy in this matter is currently being researched.

Read more about this topic:  Intraductal Carcinoma

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