Melvin Silverstein on DCIS, breast surgery, and building the first free-standing breast center

Описание: Melvin J. Silverstein, now Medical Director of Hoag Breast Center and the Gross Family Foundation Endowed Chair in Oncoplastic Breast Surgery at USC, sat down with Stacy Wentworth, radiation oncologist and medical historian, to reflect on his career.

Silverstein founded the Van Nuys Breast Center in 1979. As he saw more and more and more patients with what was only recently coming to be known as ductal carcinoma in situ (DCIS), he wrote the first major textbook on the disease and developed the Van Nuys Classification for Ductal Carcinoma in Situ of the Breast as well as the USC Van Nuys Prognostic Index.

Wentworth asked Silverstein about a time when his science was challenged by the medical establishment.

At the time, most surgeons favored treating DCIS just like aggressive, invasive breast cancers, with mastectomy and radiation.

Silverstein wasn’t so sure about that. He felt that, in some cases, radiation wasn’t necessary.

Silverstein debated against radiation oncologists at conferences for years, and his arguments stirred up visceral responses, he recalls.

“Pro-radiation therapy were all the radiation oncologists from academic centers. That was Jay Harris, who was I guess my arch rival in this. He once, after one of these talks, came up to me, smiled at me and said, ‘You're killing patients.’ Which broke my heart,” Silverstein said. “It was a terrible thing. He said to me after not giving radiation therapy, but it turns out in the long run, everybody's come on board. And clearly now it's 25, 30 years later, some people have finally agreed that they all don't need it.”

Recent trial results have confirmed Silverstein’s analysis that not all patients with DCIS need radiation.

Today, Silverstein runs the USC breast fellowship program, which has an emphasis on oncoplastic surgery—the first of its kind.

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