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Dissecting breast cancer treatments.

The improved technology and expanded use of mammography have led to an increase in the detection of abnormal cell division in women's breasts. But not all of these abnormalities require the aggressive treatment that is typical for most breast cancers, caution experts in the field.

In the United States, mammograms detect noninvasive breast cancer in 25,000 women a year, but up to four times as many women may have these microscopic tumors, says Melvin J. Silverstein of the Breast Center in Van Nuys, Calif. Only half of these tumors become invasive, he adds.

Called ductal carcinoma in situ, this disease does not require removal of the breast or lymph nodes in the adjacent armpit, two studies confirm. In one, Silverstein treated 285 women whose tumors remained confined to the ducts and 47 whose breasts contained cancer cells outside the affected ducts. He removed the cancerous cells but not the adjacent lymph nodes and saw no difference in the rates at which tumors reappeared.

The second study, involving 819 women, suggests that radiation treatment should follow the removal of the affected part of the breast. After four years, tumors developed in 57 of the 403 women who underwent lumpectomy but in only 20 of the 409 women who underwent lumpectomy plus radiation treatment, reports Donald L. Wickerham of the University of Pittsburgh Medical Center.

However, Silverstein cautions that radiation might only delay the return of disease and that over a longer period, the difference between the two groups might diminish.
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Title Annotation:study indicates that not all ductal carcinoma in situ will become invasive
Author:Pennisi, Elizabeth
Publication:Science News
Article Type:Brief Article
Date:May 29, 1993
Words:250
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