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Format: 04/18/2014
Format: 04/18/2014


Allegheny Health Network Cancer Specialists Urge Research into Individual Risk for Women with Noninvasive Breast Tumors

Friday, October 11th, 2013

Ductal carcinoma in situ (DCIS), a noninvasive breast cancer that some doctors are now arguing is over-treated, needs to be evaluated according to each woman’s risk and more research is required to better evaluate that risk, two Allegheny Health Network oncologists write in the Journal of the National Cancer Institute.

Once an uncommon finding, DCIS now represents up to 25 percent of new breast cancer cases, likely because of the increased use of mammography and breast MRI, the latter of which more effectively detects the disease.

D. Lawrence Wickerham, MD, Director of the Division of Cancer Genetics at Allegheny General Hospital (AGH) and Associate Chairman of the National Surgical Adjuvant Breast and Bowel Project  (NSABP), and Thomas B. Julian, MD,  Associate Director of the Breast Care Center at AGH and Senior Surgical Director of Medical Affairs, NSABP, also argue that refraining from calling DCIS “cancer,” as some physicians are suggesting, would be little more than a “semantic exercise” that would likely not change women’s decisions on treatment.

Somewhat less than half of DCIS proceeds to invasive cancer and most women choose breast-conserving surgery to remove the tumor. 

Drs. Wickerham and Julian write that when DCIS does develop into invasive breast cancer, it carries an increased mortality risk.  At present, doctors cannot predict whether any woman’s DCIS will be aggressive.

“In the breast clinic, it might be nice to avoid the label ‘breast cancer’ when speaking of or to DCIS patients, along with the fear and anxiety that can accompany those words,” Drs. Wickerham and Julian write. “Nevertheless we do need to inform our patients that DCIS, by any name, is more than a minor medical nuisance.”

The best solution would be to develop the ability to identify each DCIS patient’s likely prognosis and response to various therapies, Drs. Wickerham and Julian write.

The Oncotype DX genetic test, which is showing promise in predicting breast cancer recurrence, is a step in the right direction in this regard.

“At a time when we are beginning to use biologically based assessments in the treatment of patients with invasive breast cancer, we should attempt the same for those with DCIS,” the doctors write.

More research into the molecular biology and genetics of this entity are needed to help DCIS patients, and studies  of these patients’ educational and psychosocial needs are also needed  to assist them in making the best decision about treatment for their individual case.”

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