I want to draw your attention to an exciting study that was recently published online in the Journal of the National Cancer Institute and that is truly deserving of the media attention it has received. (I know some of the researchers at the University of California, San Francisco, who authored this paper, and have been following their work for years.)

Why am I so excited? Well, this is the first time that scientists have discovered biomarkers that appear to predict which women with the pre-cancer ductal carcinoma in situ (DCIS) are most likely to go on to develop invasive breast cancer and which are not.  In addition they identified a separate group that was more likely to have a local recurrence of DCIS.  Interestingly these two groups were not the same.

Right now, when a woman is diagnosed with DCIS, she is typically told that she will need to have a lumpectomy, radiation, and possibly five years of hormone therapy. For women with extensive DCIS throughout their breast, the recommended treatment is typically a mastectomy.  (In addition, some women choose to have a mastectomy even if they could have a lumpectomy.) These treatments are not being given because a woman has cancer. A DCIS diagnosis means the woman is at high risk for developing breast cancer and the treatments are given to reduce that risk.

We’ve known for some time that many women with DCIS are being overtreated, because we know that, in general, only about 20 to 30 percent of DCIS will go on to become invasive breast cancer if left untreated! But because we have not had any way of knowing which women with DCIS needed treatment, and which did not, doctors recommended that every woman be treated.

The UCSF researchers tried to determine which type of DCIS was most likely to go on to become invasive cancer and thus needed to be treated, by looking at slides that were made from tissue that was taken from 1,162 women aged 40 years and older who had been diagnosed with DCIS years ago and had been treated with lumpectomy alone.

As has been shown many times before, the study found that DCIS that appears as a lump is more likely to become invasive than DCIS that is found on a screening mammogram. More interesting, however, was that the study found that when the DCIS found on mammography contained three biomarkers— p16, cyclooxygenase-2 and Ki67—it was more likely to go on to develop into invasive breast cancer within eight years than was the DCIS that did not contain these biomarkers.

Specifically, women whose DCIS was identified by mammography and contained these three biomarkers had a 20% chance of developing invasive cancer, while women whose DCIS did not have these biomarkers only had a 4% chance of going on to develop invasive breast cancer.

The study also identified markers that suggested there were a second group of DCIS patients who were more likely to have their DCIS recur. Since this group had a DCIS recurrence and did not develop an invasive cancer, it could be that they had more extensive DCIS throughout the duct.  This suggests that it might be possible for this type of DCIS to be watched closely rather than be aggressively treated.

This study was a retrospective study, but because the study’s findings were so significant they will most likely be tested in a prospective study soon.  This prospective clinical trial would enroll women who had been diagnosed with DCIS and it might look something like this: Women whose DCIS was detected as a lump or produced biomarkers that showed it was aggressive would be given aggressive treatment, including tamoxifen, radiation, and maybe even mastectomy, while women whose DCIS was detected on mammography and produced biomarkers that showed it was very low risk might have a lumpectomy or five years of tamoxifen, or undergo surveillance—what we might call “watchful waiting.”

Bottom line: If you are diagnosed with DCIS tomorrow, these findings won’t change how you are treated. But I will venture to guess that in 10 years (or less) they probably will!

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20 Responses to A Big Discovery for DCIS

  1. Bev Lowe says:

    Very interesting. How do I find out what my biomarkers were?

  2. thank you susan for keeping the fight up to find out what is really causing bc and the unnecessary treatments so many women go thru and if they survive manytimes have lymphedema which can be a significant disability i am ten years out slow growing tumour stage one had only lumpectomy and radiation skipped the chemo….and my cousin is nancy dydo shanley she did invent a stent for cardio and sold it to J&J she says hi

  3. Gale Lang says:

    I was diagnosed in June 2002 with DCIS,,opted for a mastectomy and surgery on 4-2-2002,, no chemo no radiation and sentinal node clear. I am approaching my 8th year.. Just had my mammo and it came back negative..
    So far so good…

  4. Gale Lang says:

    Sorry typo it was July not April

  5. Dr Anupama Mane says:

    Very interesting study. Opens up a lot of possibilities for treatment of DCIS.

  6. PATRICIA CHESNEY says:

    DR. LOVE
    THANK YOU FOR ALL YOUR DEDICATION & INFO.I WILL BE ON MY 5 YR MARK IN JAN. HAD THE RADIATION & END TAMOXIFIN IN JAN.CAN THE HOSP CK NOW TO SEE WHAT BIOMARKERS WERE THERE? WHAT ARE THE ODDS FOR IT RETURNING? THE CLOSER THE 5TH YR. THE MORE I FEAR. EVERY DAY IS A THREAT.
    PAT C

  7. Julia says:

    I had massive DCIS in one breast and microinvasive LCIS that was only detected in path lab. Other breast removed preventively contained hyperlasmia cells. I find it frustrating that I have to wait 10 years to get tested. I live in DAILY fear of reoccurence. Can any one tell me how I can get into a study asap? Will pay travel

  8. Bev Lowe says:

    I just read my pathology report dated 6/4/03. Testing for biomarkers was not the norm in 2003. It’s interesting to read this report. I was lucky enough to only need a lumpectomy and radiation. But, it is always in the back of mind that there could be a reoccurence or an appearance in my other breast. I would love to find someone who could read this report in relation to the recent study findings.

  9. mona says:

    i hve been dignoses dcis with hypo.
    i can not tke tamaxofine and i left alone they find it apr 2009 and they are just watching me.pls let me know what should i do?
    i just did lumpectomy . should i remove my breast?

  10. patrice says:

    Does this study have any implications for women who have had atypical lobular hyperplasia?

  11. Linda DeLong says:

    How do you find out what the biomarkers were if surgery was 4 or 5 years ago?

  12. Denise says:

    Thank you for keeping up the fight of breast cancer. I had DCIS 8 years ago. Had lumpectomy,radiation, tamoxofin for 5 years.:was negative on sentinal node biopsy. Now a year and a half ago had reoccurence and had double mastectomy with reconstruction. It was only in one breast but didn’t want to take any chances. Hopefully women will not have to go through all this in the future.

  13. Jackie says:

    Why is there always so much discussion about DCIS and almost nothing about LCIS. Both are killers, but LCIS seems to get almost no attention. I had a double mastectormy 3 yrs. ago, as I didn’t want to go through a second major surgery. Follow your info, but continually feel that I only get half the story. Hope to hear from you.

    Jackie Mullery

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    Haha, Yes, i also really like to visit new place,your idea is good. :D

  16. Susan Monaster says:

    I had a lumpectomy for DCIS in December, 2007. Is it possible to have the pathology looked at for theses markers?

  17. Ilona SIlverman says:

    The study on DCIS blows my mind.
    Jan. 2008, I underwent a wire guided procedure for hyperplasia in left breast.
    Feb. 2009, dx was DCIS in left breast.
    My choice was dbl. mastectomy with reconstruction immediately thereafter.
    With my lumpectomy being so painful for so long, I was small breasted, I did not check it for normal breast exams…When I saw my PC for mammo referral, she totally missed the small pea in my left breast. Thank god days later the mammo picked it up.
    March 17, 2009, I was a stage 0, no sentinel node involvement, no chemo or radiation..I was declared cancer free!
    Can I find out what my markers were if i choose now?
    Reading these comments blow my mind feeling the angst of women fearing from reoccurence. I cried when I read that markers were identified in the study.
    There is so much hope out there for women with breast cancer.
    Please continue the marvelous work and The Army of Women that Dr. Susan Love has began.
    I love you all.

  18. Diana Carver says:

    I was wondering if they have been doing a study with reoccurance. I was diagnosed in 2000 with DCIS on right side, 2 lumpectomies, chemo and radiation. Nine yrs later
    Infiltrating Lobular Carcinoma on left side. Had chemo to shrink 3 tumors, dbl mastectomy with 27 radiation treatments. One node postive.
    On Arimedex for 5 years. I thought I was clear after none years, but you have to stay pro-active.

  19. Marie Monteagudo says:

    I was diagnosed with stage 0 DCIS in 94 and had a lumpectomy with 6 weeks of radiation. In March of this year, I was diagnosed with stage 1 invasive ductal carcinoma and some DCIS. I am now undergoing 6 rounds of Chemo. My doctor did not recommend Tamoxifen in the intervening years; when I had a “scare” 2+ year ago, I asked her for Evista. So I wonder if I could have prevented this recurrence if I had Tamoxifen or Evista earlier? My lesson is “Be vigilant, and empower myself!” Will Dr. Love update her 2005 Dr. Susan Love’s Breast Book soon?

  20. Debbie McClusky says:

    I had DCIS/INVASIVE breast cancer 8 years ago – now diagnosed with DCIS in other breast. What is the treatment? I have been told surgery/radiation, is this enough?

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