Although the primary role of adjuvant systemic therapy is to treat occult distant disease, there may also be a local benefit, at least in ductal carcinoma in situ trial (DCIS). The NSABP trial B-24 randomized 1,804 women with DCIS treated with lumpectomy plus radiation to no further therapy or to 5 years of tamoxifen.52 At 5 years, tamoxifen decreased the risk of the development of invasive breast cancer in the treated breast by 47 percent (2.1% versus 3.4% in control, p = .04) and of all breast cancer events (ipsilateral and contralateral) by 34 percent (8.8% versus 13% in control, p = .007).52 These results apply only to women who had lumpectomy/radiation for DCIS. They are not relevant to women treated with mastectomy. While the absolute magnitude of the benefit was small, certainly tamoxifen should be considered in many women with DCIS treated with breast conservation, particularly those with high-risk pathology.
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