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Radiation for DCIS?

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“Four large randomized trials have studied the effects of postoperative radiotherapy after breast conserving surgery in patients with wider spectrum of DCIS and all of them have shown radiotherapy to halve the risk of ipsilateral events, however, without any significant effect on breast cancer mortality.”

One of the most frequently asked questions I receive on PeopleBeatingCancer is from one of the 60,000 women who have been diagnosed with Ductal Carcinoma In-Situ (DCIS- breast cancer stage 0)- if they should have radiation after their lumpectomy- after they surgically remove the abnormal cells that caused the DCIS diagnosis.

The studies linked below addresses that very question. If you are wondering about local radiation after a diagnosis of DCIS, the increased risk of a relapse in the same breast is outlined below. I will summarize.

After an average follow-up of six years:

  • the average rate of recurrence for DCIS patients was 3.1%
  • Women who received radiation within 8 weeks the rate of recurrence was 2.5%
  • Based on 60,000 DCIS diagnoses annually, that means that .6% or 5400 women will relapse with another diagnosis of DCIS or invasive breast cancer in the same breast by delaying radiation-

There was no mention in the article linked below of the collateral damage such as heart damage or secondary cancers caused by the radiation nor was there any mention if a BC recurrence led to metastatic BC.

Further, what also was no mentioned in the article were the evidence-based therapies that lower the risk of breast cancer relapse including

  • nutrition,
  • supplementation,
  • and lifestyle therapies.

You read that correctly. Evidence-based, non-toxic therapies that reduce your risk of DCIS relapse.

To learn more about DCIS and the evidence-based therapies that can help you prevent its spread into invasive breast cancer, please watch the video below-

To learn more about non-toxic therapies shown to reduce the risk of DCIS relapse, please scroll down the page, write a question or a comment and I will reply ASAP.


David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Delaying radiation therapy for women with very early breast cancer ups recurrence

“Stage 0 breast cancer — or ductal carcinoma in situ (DCIS) — is diagnosed based on the presence of abnormal cells in the milk ducts of the breast. Every year, more than 60,000 U.S. women are diagnosed with DCIS, and experts often debate how best to treat it because the abnormal cells don’t always develop into full-blown, or invasive, breast cancer

During the average six years of follow-up, 3.1 percent of women developed a recurrence of DCIS or an invasive tumor in the same breast. For women who received radiation within eight weeks, the rate of recurrence was 2.5 percent. After adjusting for age, race, pathological factors, surgical margin status and hormone therapy, the risk of breast cancer recurrence was 26 percent higher for women who had delayed radiation therapy and 35 percent higher for women who did not initially receive radiation…”

Postoperative radiotherapy after DCIS: Useful for whom?

“The number of patients with ductal carcinoma in situ (DCIS) increases with more widely used screening mammography programs. DCIS accounts for approximately 20% of all new breast cancer diagnoses in these programs and the natural course of this heterogeneous group of pre-invasive lesions is not fully known.

Better definition of subgroups benefitting from radiotherapy and knowledge on the natural course of DCIS are important issues for the future management of DCIS. Four large randomized trials have studied the effects of postoperative radiotherapy after breast conserving surgery in patients with wider spectrum of DCIS and all of them have shown radiotherapy to halve the risk of ipsilateral events, however, without any significant effect on breast cancer mortality.

SweDCIS is one of these four randomized trials (n = 1046) and with 20 years follow-up the relative risk reduction for an ipsilateral event was 37.5% and the absolute reduction was 12%. For an in-situ ipsilateral event the absolute reduction was 10% and for an invasive ipsilateral event the reduction was 2%. The reduction of new events in the SweDCIS was most evident during the first decade after treatment.

In RTOG 9804 patients in a good-risk subset of DCIS were randomized to radiotherapy or not and with seven years of follow-up the ipsilateral local failure rate was 0.9% and 6.7% in the two arms, respectively. Radiotherapy to the conserved breast may also give long-term side effects in a small proportion of the patients, in which experience of breast pain is the most common, reported in about 10% of the patients.

With modern radiotherapy techniques the dose to the heart can be restricted to low levels and meta-analyses from the randomized DCIS trials showed no difference in non-breast cancer mortality. Several factors in different trials have shown to influence the risk for an ipsilateral event: age, size, grade, necrosis, clear margin, and detected on mammography or not.

But identification of subgroups without relative efficacy of radiotherapy has been challenging to find. The Van Nuys prognostic index and the nomogram from the Memorial Sloan-Kettering take several of these factors into account. These and genomic assays may help to optimize the treatments of patients with DCIS.

Still, radiotherapy after breast conserving surgery is the standard of care for a majority of DCIS patients. For some low risk DCIS patients accepting a slight increased risk of an ipsilateral event it is reasonable to omit radiotherapy after close communication with the patient about pros and cons of radiotherapy.”


Leave a Comment:

Kim says a couple of years ago

I just recently had surgery for DCIS. I’m contemplating having radiation. I have seen a lot of statistics and would like more information on DCIS grade 3. None of the articles seem to differentiate the odds between low to moderate and grade 3. I have completely changed my diet and added more supplements but am still unsure if 4 weeks of radiation is needed.

    David Emerson says a couple of years ago

    Hi Kim-

    I sent the DCIS guide to you via your email address.

    Good luck.

    David Emerson

Sue says 6 years ago

Hi David,
I have been recently diagnosed with DCIS. I’m interested in having lumpectomy and anti-hormonal treatment without radiation. Interested in your opinion.

    David Emerson says 6 years ago

    Hi Sue-

    Several things. Keep in mind that DCIS is pre-cancer, not cancer. Yes, this diagnosis is difficult and scary but try to keep it in perspective. Secondly, while my role is to give you evidence-based information and research, and yes, my thinking, only you can decide what is best for you.

    The therapies you list- lumpectomy, anti-hormonal therapy and radiation, all have been developed in an effort to reduce the patient’s (you) risk of relapse or in this case, a diagnosis of full blown breast cancer. The real issue, in my view, it less about “relapse” and more about dieing of breast cancer. The short, long-term and late stage side effects of radiation therapy, in my opinion, are under reported and should be studied more. But this is just my feeling…

    The next issue then, is to further reduce the risk of breast cancer. I encourage you to consider taking the Oncotype DX DCIS test to learn more about your risk of relapse.

    The next step is to learn about and adopt those evidence-based, non-toxic therapies shown to reduce the risk of BC. Nutrition, supplementation, exercise, etc. all have been shown to reduce the risk of BC. As a cancer survivor myself, I subscribe to the practice of non-toxic therapies shown to reduce the risk of one’s cancer relapse.

    As an aside, supplements such as curcumin and omega 3 fatty acids have been shown to both reduce the risk of BC as well as reduce the syptomsof therapies like tamoxifen.

    Please read this article as I think it phrases the issues-click now-

    All to say that if you choose not to undergo radiation therapy, and follow the above, you can reduce your risk of relapse to a tiny fraction and may experience much higher quality of life.

    My apologies for being so long-winded above. Let me know if you have questions or if you want me to provide specific therapies for you to consider.

    thanks and hang in there,

    David Emerson

Jean says 6 years ago

What are some non-toxic therapies shown to reduce the risk of DCIS relapse?

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