DCIS and treatment

[aerial]

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There was a very interesting article (published in yesterday's Cancer) on DCIS. I know this is not the pathology forum but I'm always up for showing some love for the microscope, and this study did a good job of doing so: the data came from the pre-mammography era (1950-60's) which allowed researchers to see how the cancer progressed microscopically and how those findings translated into a diagnosis.

What I found even more interesting was a quote from an oncologist who said that radiation treatment for patients on the East Coast is recommended whereas on the West Coast its used more conservatively. (Conservative thoughts out West?? What a funny thought! I guess Arnold is doing a good job out there!) What do you guys think about this? Is this true-- if so, why? Is there not a general standard or set of guidelines by which this is treated? Are there any other cancers that have such bicoastal differences in opinion?

 

[stephew]

this is due to the van nye's /silverstein data which is rather questioable as its not randomized.

 

[MSTP boy]

Treatment regimens may vary substantially by city, region, or coast in other medical fields too. In the case you mention, I think the rationale may be partly based on economics. I think that there may be a greater density of radiotherapy centers in the East.

 

[dmchaffie]

there was a DCIS study that came out of Harvard that showed a much lower recurrence rate in the +RT arm compared to the -RT arm, but an equal disease free survival at 99%. as I understand it, the van nuys data is based upon a surgical approach that is not standard of care, which includes much wider margins with procedures performed in conjuction with plastic surgery. for this reason the data is not completely accepted. i believe that i would argue that the addition of RT is the conservative approach based upon what i understand is coming from van nuys.

There was a very interesting article (published in yesterday's Cancer) on DCIS. I know this is not the pathology forum but I'm always up for showing some love for the microscope, and this study did a good job of doing so: the data came from the pre-mammography era (1950-60's) which allowed researchers to see how the cancer progressed microscopically and how those findings translated into a diagnosis.

What I found even more interesting was a quote from an oncologist who said that radiation treatment for patients on the East Coast is recommended whereas on the West Coast its used more conservatively. (Conservative thoughts out West?? What a funny thought! I guess Arnold is doing a good job out there!) What do you guys think about this? Is this true-- if so, why? Is there not a general standard or set of guidelines by which this is treated? Are there any other cancers that have such bicoastal differences in opinion?

 

[stephew]

van nuyes is has been significantly criticised for scientific approach (not just by radoncs). and the margin issue is a good point. In any event, if youre at the radonc boards, you had better offer RT.