Characterizing the impact of 25 years of DCIS treatment

Ozanne, Elissa M.; Shieh, Yiwey; Barnes, J. Matthew; Bouzan, Colleen; Hwang, E. Shelley; Esserman, Laura J.

doi:10.1007/s10549-011-1430-5

Cited by 104 publications

(90 citation statements)

References 38 publications

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“…In 2015, it is estimated that 40 290 women will die from the disease and that 231 840 new cases will be reported 1. Of the newly diagnosed cases, more than 60 000 will be ductal carcinoma in situ (DCIS), a heterogeneous premalignant condition of uncertain malignant potential that likely has a component of overdiagnosed disease, resulting in unnecessary surgical procedures and chemotherapy for some patients 2. Long non-coding RNA (lncRNA) is defined as transcribed non-coding RNA molecules >200 nucleotides in length.…”

Section: Introductionmentioning

confidence: 99%

Long non-coding RNA chromogenic in situ hybridisation signal pattern correlation with breast tumour pathology

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Long non-coding RNA chromogenic in situ hybridisation signal pattern correlation with breast tumour pathology

et al. 2015

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“…2 We now know that breast cancer encompasses a range of behaviors, from aggressive to indolent; the latter are more likely to surface with screening. 3 The analysis of Narod et al 4 fuels a growing concern that we should rethink our strategy for the detection and treatment of DCIS.…”

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confidence: 99%

Rethinking the Standard for Ductal Carcinoma In Situ Treatment

Esserman

Yau

2015

JAMA Oncol

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The original goal of mammographic screening was to identify invasive cancers at the earliest stage, because of the superior prognosis of stage I cancers. Prior to the advent of screening, ductal carcinoma in situ (DCIS) made up approximately 3% of breast cancers detected. As we pushed to find smaller and smaller cancers, and targeted calcifications instead of just masses, we began to identify DCIS more frequently. Now DCIS accounts for approximately 20% to 25% of screen-detected breast cancers. The cells that make up DCIS look like invasive cancer both pathologically and molecularly, and therefore the presumption was made that these lesions were the precursors of cancer and that early removal and treatment would reduce cancer incidence and mortality. However, long-term epidemiology studies have demonstrated that the removal of 50 000 to 60 000 DCIS lesions annually has not been accompanied by a reduction in the incidence of invasive breast cancers.1 This is in contrast to the experience with removal of colonic polyps and intraepithelial neoplasia lesions of the cervix, in which the removal of precursor lesions has led to a decrease in the incidence of colon and cervical cancer, respectively. 2 We now know that breast cancer encompasses a range of behaviors, from aggressive to indolent; the latter are more likely to surface with screening. 3 The analysis of Narod et al 4 fuels a growing concern that we should rethink our strategy for the detection and treatment of DCIS. As demonstrated by Narod and colleagues 4 in this large observational study of more than 100 000 women with a diagnosis of DCIS, the risk of dying from breast cancer is low. Less than 1% of patients in this 20-year study died of breast cancer (compared with 5% of patients who died of other causes). Using the Kaplan-Meier method, the breast cancer-specific mortality rate is 3.3% at 20 years, not dissimilar to the statistic that the American Cancer Society 5 says is the chance that the average woman will die of breast cancer. This is welcome news and suggests that we can embrace evaluation of alternative strategies to surgery and radiation therapy. CALGB 40903, 6 a neoadjuvant study of 6 months of letrozole therapy, is an example of a new approach and should open the door to trials of observation and endocrine risk-reducing therapy. If invasive cancer develops after DCIS, the risk of dying of breast cancer increases substantially. Because the biological characteristics of DCIS often predict the type of cancer that may develop in the future, the value of a DCIS diagnosis may be in providing a clue about how to more specifically prevent a potentially lethal breast cancer.A second important insight from the article by Narod et al 4 is that there are uncommon cases in which DCIS has a higher risk than has been appreciated. When DCIS is diagnosed before the age of 35 or even 40 years, some of these lesions do pose an increased risk of breast cancer-specific mortality. Ductal carcinoma in situ diagnosed before the age of 40 years is likely different becaus...

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“…Furthermore, with the recognition that the rates of invasive cancer have not decreased proportionately as a result of identifying and treating mammographically detected DCIS, there is an intense focus on reevaluating our current management recommendations for DCIS [10]. The NCCN guidelines include a category 2A recommendation (''Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate'') for WLE alone [5].…”

Section: Introductionmentioning

confidence: 99%

Is Wide Excision Alone an Appropriate Therapy for DCIS?

Singh

Kulkarni

2015

Curr Surg Rep

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With the widespread use of screening mammography, the number of ductal carcinoma in situ (DCIS) cases has increased dramatically. Current treatment includes wide local excision (WLE) and adjuvant radiation therapy (RT). The benefit of RT in decreasing local recurrence was established based on the results of four randomized trials and a subsequent meta-analysis. However, RT has a number of side effects and no demonstrated survival benefit in women with in situ breast cancer. This review explores the current literature on the management of DCIS with WLE alone. Although there is insufficient evidence to identify truly low-risk DCIS based on histopathological and immunohistochemical factors, emerging data appear promising in understanding the biological behavior of DCIS. In particular, the Oncotype DX DCIS Score, a multigene assay, predicts local recurrence in women treated with WLE. Risk stratification of DCIS to guide treatment decisions remains elusive, but one of great importance in tailoring therapies to the biology of this heterogeneous disease.

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Characterizing the impact of 25 years of DCIS treatment

Cited by 104 publications

References 38 publications

Long non-coding RNA chromogenic in situ hybridisation signal pattern correlation with breast tumour pathology

Long non-coding RNA chromogenic in situ hybridisation signal pattern correlation with breast tumour pathology

Rethinking the Standard for Ductal Carcinoma In Situ Treatment

Is Wide Excision Alone an Appropriate Therapy for DCIS?

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