Letters to the Editor

Controversies in Breast Cancer

To the Editor -- I would like to comment on Controversies in Breast Cancer by Frank J. Cummings, MD, and Nabil Saba, MD, the May/June issue of Cancer Control.¹

When the authors discuss lobular carcinoma in situ (LCIS), they indicate that there is no role for tamoxifen with LCIS. However, when they discuss ductal carcinoma in situ (DCIS), they refer to the NSABP’s B-24 trial. The NSABP also has the Breast Cancer Prevention Trial (BCPT), which is examining the role of tamoxifen in the prevention of breast cancer in women at high risk (LCIS, family history, or age over 60 years), and Cancer Control featured an article on the Breast Cancer Prevention Trial by Bernard Fisher, MD, and Joseph Costantino, DrPH, of the NSABP in January/February 1997.² As the authors point out, the management of LCIS is controversial, yet to flatly state that no role exists for tamoxifen suggests that the BCPT has no value in clarifying a possible treatment option for these patients. In June, the NSABP announced that the results of the BCPT (with 13,000+ participants enrolled) will probably be available within two to three years, which is far earlier than predicted. Until medical research has proved or disproved the role of tamoxifen with LCIS, we can remain hopeful that the BCPT will provide women with LCIS an additional option to the two present approaches: long-term surveillance or risk-reducing mastectomies.

Randy Gross, MS, RN, CS, AOCN
Evelyn H. Lauder Breast Center
Memorial Sloan-Kettering Cancer Center
205 E 64th Street, Level 1
New York, NY 10021

From the Authors -- We would like to thank Randy Gross for clarifying and expanding on the role of tamoxifen in LCIS. Presently, there is no established role for the routine use of tamoxifen in treating LCIS. The Breast Cancer Prevention Trial of the NSABP includes LCIS patients among eligible women, and data may yet appear to support the use of tamoxifen in this setting, provided a large enough cohort of LCIS patients are entered to allow definitive conclusions on tamoxifen efficacy. Physicians, nurses, and patients are encouraged to participate in this important ground-breaking clinical trial so we may get answers to some of these unresolved issues.

Frank J. Cummings, MD, and
Nabil Saba, MD
Division of Oncology/Hematology
Department of Medicine
Roger Williams Medical Center
825 Chalkstone Avenue
Providence, RI 02908

1. Cummings FJ, Saba N. Controversies in breast cancer. Cancer Control:JMCC. 1997;4:226-235.

2. Fisher B, Costantino J. Highlights of the NSABP Breast Cancer Prevention Trial.Cancer Control: JMCC. 1997;4:78-86.

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