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Predicting Progression of DCIS to Future Invasive Breast Cancer

Posted Apr 29 2010 7:29am
Ductal Carcinoma In Situ (DCIS) is the most common form of non-invasive breast cancer.  Early treatment for DCIS was surgical removal of the lump in the breast.  However, the breast cancer typically returned in about 30% of the patients with breast cancer recurrence being either another DCIS or invasive breast cancer, which is a more severe form of breast cancer.  Unfortunately, it has not been possible in the past to determine which recurrences would be DCIS or the more severe invasive breast cancer.  A new research study published in the Journal of the National Cancer Institute reports on a way to predict which DCIS breast cancer patients will be at higher risk for future development of invasive breast cancer.

In their new breast cancer study , the researchers collected medical histories from 1,162 women diagnosed with DCIS breast cancer and treated with lumpectomy alone from 1983 to 1994.  Of these breast cancer patients, 324 experienced breast cancer recurrence in the form of either DCIS or invasive breast cancer.  The researchers analyzed the medical histories of the breast cancer patients and the tissue characteristics of their subsequent breast cancer tumors in an attempt to determine what characteristics might predict the development of invasive breast cancer.  The breast cancer researchers reported
  • Women who detected their initial DCIS by palpation were at a greater risk for developing invasive breast cancer compared to women who had their initial DCIS detected by mammography.
  • Breast cancer patients with DCIS tumors characterized by the presence of breast cancer markers p16, COX-2, and Ki67 combined were at a substantially higher risk of developing future invasive breast cancer compared to breast cancer patients that were negative for all three of these markers.
  • Alternate tissue marker profiles and large disease-free margins were associated with breast cancer recurrence in the form of the less aggressive DCIS.
These are potentially important breast cancer research findings that might positively impact treatment decisions.  While DCIS breast cancer patients have a 30% chance of breast cancer recurrence if they opt for treatment by lumpectomy alone, this apparently is no longer considered standard of care for DCIS patients.  According to an accompanying editorial , most DCIS breast cancer patients are now treated with lumpectomy + radiation therapy and possibly hormone therapy in estrogen receptor - positive DCIS.  These new standard therapies have reduced the risk of recurrence to about 10% overall and less than 5% for invasive breast cancer.  Nonetheless, this new research would allow DCIS breast cancer patients some options in regards to personalizing their breast cancer therapy.  Women at very low risk of recurrence might opt for less aggressive forms of breast cancer therapy.

Improvements in determining what increases the risk for breast cancer or breast cancer recurrence are welcome steps forward in breast cancer research because it provides an opportunity to develop ways to decrease that risk.  To learn about diet and lifestyle changes you can make to reduce your personal breast cancer risk, read my book Fight Now: Eat & Live Proactively Against Breast Cancer .
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