Ductal Carcinoma In Situ: Challenges, Opportunities, and Uncharted Waters

2012 ◽  
pp. 40-44 ◽  
Author(s):  
Abigail W. Hoffman ◽  
Catherine Ibarra-Drendall ◽  
Virginia Espina ◽  
Lance Liotta ◽  
Victoria Seewaldt
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Targeted Prevention ◽  
Breast Cancers ◽  
Increased Risk

Overview: Ductal carcinoma in situ (DCIS) is a heterogeneous group of diseases that differ in biology and clinical behavior. Until 1980, DCIS represented less than 1% of all breast cancer cases. With the increased utilization of mammography, DCIS now accounts for 15% to 25% of newly diagnosed breast cancer cases in the United States. Although our ability to detect DCIS has radically improved, our understanding of the pathophysiology and factors involved in its progression to invasive carcinoma is still poorly defined. In many patients, DCIS will never progress to invasive breast cancer and these women are overtreated. In contrast, some DCIS cases are clinically aggressive and the women may be undertreated. We are able to define some of the predictors of aggressive DCIS compared with DCIS of low malignant potential. However, our ability to risk-stratify DCIS is still in its infancy. Clinical risk factors that predict aggressive disease and increased risk of local recurrence include young age at diagnosis, large lesion size, high nuclear grade, comedo necrosis, and involved margins. Treatment factors such as wider surgical margins and radiation therapy reduce the risk of local recurrence. DCIS represents a key intermediate in the stepwise progression to malignancy, but not all aggressive breast cancers appear to have a DCIS intermediate, notably within triple-negative breast cancer. Ongoing studies of the genetic and epigenetic alterations in precancerous breast lesions (atypia and DCIS) as well as the breast microenvironment are important for developing effective early detection and individualized targeted prevention.

scholarly journals Relationship Between Anthropometric Factors and Risk of Second Breast Cancer Among Women With a History of Ductal Carcinoma In Situ

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Meghan R Flanagan ◽  
Mei-Tzu C Tang ◽  
Michelle L Baglia ◽  
Peggy L Porter ◽  
Kathleen E Malone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Cancers ◽  
Increased Risk ◽  
History Of ◽  
Second Breast Cancer ◽  
The Impact

AbstractBackgroundWomen with ductal carcinoma in situ (DCIS) have an elevated risk of a second breast cancer, but few data are available regarding the impact of modifiable lifestyle factors on this risk.MethodsIn a population-based case–control patient study of women with a history of DCIS in western Washington diagnosed between 1996 and 2013, 497 patients diagnosed with DCIS and a second ipsilateral or contralateral invasive or in situ breast cancer were enrolled. There were 965 matched control patients with one DCIS diagnosis. Associations between anthropometric factors and risk of an invasive or in situ second breast cancer event were evaluated using conditional logistic regression. Statistical tests were two-sided.ResultsObesity (body mass index [BMI] ≥ 30 kg/m2) at initial DCIS diagnosis was associated with a 1.6-fold (95% confidence interval [CI] = 1.2 to 2.2) increased risk of any second breast cancer and a 2.2-fold increased risk of a contralateral second breast cancer (95% CI = 1.4 to 3.3) compared with normal weight women (BMI < 25 kg/m2). BMI and weight, both at initial DCIS diagnosis and at the time of the second breast cancer diagnosis, were positively associated with risk of any second and second invasive breast cancers (odds ratio = 1.01–1.04, all P ≤ .03).ConclusionsAlthough additional confirmatory studies are needed, obesity appears to be an important contributor to the risk of second breast cancers within the growing population of women with DCIS. This has potential clinical relevance with respect to identifying which women with a history of DCIS may require more careful monitoring and who may benefit from lifestyle modifications.

The management of ductal carcinoma in situ of the breast.

2001 ◽  
pp. 33-45 ◽  
Author(s):  
K A Skinner ◽  
M J Silverstein
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Lessons Learned ◽  
Morphological Evidence

Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous group of lesions with diverse malignant potential. It is the most rapidly growing subgroup within the breast cancer family with more than 42 000 new cases diagnosed in the United States during 2000. Most new cases are nonpalpable and are discovered mammographically. Treatment is controversial and ranges from excision only, to excision with radiation therapy, to mastectomy. Prospective randomized trials reveal an approximate 50% reduction in local recurrence rate overall with the addition of radiation therapy to excisional surgery, but the published prospective data do not allow the selection of subgroups in whom the benefit from radiation therapy is so small that its risks outweigh its benefits. Nonrandomized single facility series suggest that age, family history, nuclear grade, comedo-type necrosis, tumor size and margin width are all important factors in predicting local recurrence and that one or more of these factors could be used to select subgroups of patients who do not benefit sufficiently from radiation therapy to merit its use. When all patients with ductal carcinoma in situ are considered, the overall mortality from breast cancer is extremely low, only about 1-2%. When conservative treatment fails, approximately 50% of all local recurrences are invasive breast cancer. In spite of this, the mortality rate following invasive local recurrence is relatively low, about 12% with eight years of actuarial follow-up. Genetic changes routinely precede morphological evidence of malignant transformation. Lessons learned from ongoing basic science research will help us to identify those DCIS lesions that are unlikely to progress and to prevent progression in the rest.

Ipsilateral invasive cancer risk after diagnosis with ductal carcinoma in situ (DCIS): Comparison of patients with and without index surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 519-519
Author(s):  
Marc D Ryser ◽  
Laura Hendrix ◽  
Samantha M. Thomas ◽  
Thomas Lynch ◽  
Anne McCarthy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Absolute Risk ◽  
Breast Conserving Surgery ◽  
Absolute Difference ◽  
Locoregional Treatment ◽  
Increased Risk

519 Background: Most women diagnosed with ductal carcinoma in situ (DCIS) undergo surgical resection, potentially leading to overtreatment of patients who would not develop clinically significant breast cancer in the absence of locoregional treatment. We compared the risk of ipsilateral invasive breast cancer (iIBC) between DCIS patients who received breast conserving surgery (BCS) for their index diagnosis of DCIS (BCS group) and patients who did not receive any locoregional treatment within 6 months of diagnosis (surveillance [SV] group). Methods: A treatment-stratified random sample of patients diagnosed with screen-detected and biopsy-confirmed DCIS in 2008-14 was selected from 1,330 Commission on Cancer-accredited facilities (20/site). Excluding patients who received a mastectomy ≤6 months, the final analytic cohort contained 14,245 (88.2%) BCS and 1,914 (11.8%) SV patients. Subsequent breast events were abstracted up to 10 years after diagnosis. Primary outcome was the 8-year absolute difference in iIBC risk between BCS and SV; a subgroup analysis was performed for grade I/II patients. A propensity score (PS) model for treatment was fitted with sampling design (SD) weighting and random effects for patients within facilities. Absolute risk differences were estimated using PS-SD-weighted Kaplan Meier estimators. Results: Overall, median age at diagnosis was 61 years (IQR: 52-69) and median follow-up was 5.8 years (95% CI 5.7-6.1). The majority of patients were Caucasian (81.9%), with estrogen receptor-positive (80.6%), and nuclear grade I/II (54.5%) DCIS. The fraction of patients with a Charlson comorbidity score of ≥2 was higher in SV (14.2%) compared to BCS (6.4%, p < 0.001). The 8-year risk of iIBC was 3.0% (95% CI: 2.4%-3.6%) for BCS and 7.7% (95% CI: 4.9%-10.5%) for SV, with an absolute risk difference of 4.7% (95% CI: 4.5%-4.9%; log-rank p < 0.001). Among patients with grade I/II tumors, the 8-year risk of iIBC was 3.1% (95% CI: 2.3%-4.0%) for BCS and 6.1% (95% CI: 2.5%-9.8%) for SV; difference: 3.0% (95% CI: 2.7%-3.2%; p = 0.005). Conclusions: Despite an increased risk of iIBC in SV patients compared to BCS patients, the 8-year risk did not exceed 10% in either group. The risk of recurrence in BCS patients was comparable to previously reported estimates. These data demonstrate a considerable degree of overtreatment among patients with non-high grade DCIS. Prospective clinical trials will help determine the tradeoffs between universally directed as opposed to selectively applied surgery for low risk DCIS.

Breast-Conserving Surgery Alone for Ductal Carcinoma In Situ: Factors Associated with Increased Risk of Local Recurrence

2016 ◽  
Vol 24 (5) ◽  
pp. 1221-1226 ◽  
Author(s):  
Alessandra Mele ◽  
Pritesh Mehta ◽  
Priscilla J. Slanetz ◽  
Alexander Brook ◽  
Abram Recht ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Factors Associated ◽  
Increased Risk

scholarly journals Genomic profiling defines variable clonal relatedness between invasive breast cancer and primary ductal carcinoma in situ

2021 ◽  
Author(s):  
Esther H. Lips ◽  
Tapsi Kumar ◽  
Anargyros Megalios ◽  
Lindy L. Visser ◽  
Michael Sheinman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Single Cell ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Invasive Disease ◽  
Clonal Relatedness ◽  
Increased Risk

Pure ductal carcinoma in situ (DCIS) is being diagnosed more frequently through breast screening programmes and is associated with an increased risk of developing invasive breast cancer. We assessed the clonal relatedness of 143 cases of pure DCIS and their subsequent events using a combination of whole exome, targeted and copy number sequencing, supplemented by single cell analysis. Unexpectedly, 18% of all invasive events after DCIS were clonally unrelated to the primary DCIS. Single cell sequencing of selected pairs confirmed our findings. In contrast, synchronous DCIS and invasive disease (n=44) were almost always (93%) clonally related. This challenges the dogma that most invasive events after DCIS represent invasive transformation of the initial DCIS and suggests that DCIS could be an independent risk factor for developing invasive disease as well as a precursor lesion.

21-Gene Assay and Breast Cancer Mortality in Ductal Carcinoma in Situ

2020 ◽  
Author(s):  
Eileen Rakovitch ◽  
Rinku Sutradhar ◽  
Sharon Nofech-Mozes ◽  
Sumei Gu ◽  
Cindy Fong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Breast Cancer Mortality ◽  
Risk Of Death ◽  
Increased Risk ◽  
Gene Assay

Abstract Background The inability to identify individuals with ductal carcinoma in situ (DCIS) who are at risk of breast cancer (BC) mortality have hampered efforts to reduce the over-treatment of DCIS. The 21-gene Recurrence Score (RS) predicts distant metastases for individuals with invasive BC, but its prognostic utility in DCIS is unknown. Methods We performed a population-based analysis of 1,362 individuals of DCIS aged ≤75 years at diagnosis treated with breast-conserving therapy. We examined the association between a high RS (defined a priori as &gt; 25) and the risk of BC mortality by using a propensity score-adjusted model accounting for the competing risk of death from other causes, testing for interactions. All statistical tests were two-sided. Results With 16 years median follow-up, 36 (2.6%) died of BC and 200 (14.7%) died of other causes. The median value of the RS was 15 (range = 0–84); 29.6% of individuals had a high RS. A high RS was associated with an 11-fold increased risk of BC mortality (HR = 11.27 95%CI = 3.00 to 42.33, p&lt;.001 in women ≤50 years of age at diagnosis treated with BCS alone, culminating in a 9.4% (95%CI= 2.3 to 22.5) 20-year risk of BC death. For women with a high RS, treatment with RT was associated with a 71% (HR = 0.29, 95%CI = 0.10 to 0.89. p = .03) relative and a 5% absolute reduction in the 20-year cumulative risk of death from BC. Conclusion The 21-gene RS predicts BC mortality in DCIS and combined with age (≤50 years) at diagnosis can identify individuals for whom RT reduces the risk of death from BC.

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